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Peripheral Arterial Disease

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PAD

NIH - Arteriosclerosis of the extremities

"Arteriosclerosis of the extremities is a disease of the blood vessels characterized by narrowing and hardening of the arteries that supply the legs and feet. This causes a decrease in blood flow that can injure nerves and other tissues. Arteriosclerosis, or "hardening of the arteries," commonly shows its effects first in the legs and feet. The narrowing of the arteries may progress to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness. The effects of these deposits may be seen on ordinary X-rays. This is a common disorder, usually affecting men over 50 years old. People are at higher risk if they have a personal or family history of coronary artery disease (heart disease) or cerebrovascular disease (stroke), diabetes, smoking, hypertension (high blood pressure), or kidney disease involving hemodialysis."

Highlighted Article

Medical treatment of peripheral arterial disease.

"CONTEXT: Peripheral arterial disease (PAD) affects approximately 20% of adults older than 55 years and is a powerful predictor of myocardial infarction, stroke, and death due to vascular causes. The goals of treatment are to prevent future major coronary and cerebrovascular events and improve leg symptoms. … CONCLUSION: The substantial and increasing burden of PAD, and its local and systemic complications, can be reduced by lifestyle modification (smoking cessation, exercise) and medical therapies (nicotine replacement therapy, bupropion, antihypertensive drugs, statins, and antiplatelet drugs)."

Visit InfoMedSearch's Home Page for all InfoMedLinks Cardiovascular Topics: Atherosclerosis, Atrial Fibrillation, Coronary Artery Disease, Cholesterol - Lipids, General Cardiovascular, Heart Failure, Hypertension, Myocardial Infarction (Heart Attack), Peripheral Artery Disease, and Stroke.

CONTINUE YOUR INFOMEDSEARCH RESEARCH with our previous InfoMedLinks. Start with InfoMedLinks 2006.

Notes

The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).

Peripheral Arterial Disease

Daily Treatment Report

In this Report:

Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Drugs
Exercise
General Information
Guidelines
Immunotherapy
Internet Sites
Nutrition
Other
Radiotherapy
Supplements-Vitamins-CAM
Surgery
Transplantation

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Endovascular stent implantation for treatment of peripheral artery disease. (Eur J Clin Invest. 2007)

Drug Side-Effects and Interactions

Drugs

Lipid-lowering for peripheral arterial disease of the lower limb. (Cochrane Database Syst Rev. 2007)

Oral Anticoagulant and Antiplatelet Therapy and Peripheral Arterial Disease. (N Engl J Med. 2007) "CONCLUSIONS: In patients with peripheral arterial disease, the combination of an oral anticoagulant and antiplatelet therapy was not more effective than antiplatelet therapy alone in preventing major cardiovascular complications and was associated with an increase in life-threatening bleeding."

Statins and peripheral arterial disease: effects on claudication, disease progression, and prevention of cardiovascular events. (Arch Med Res. 2007)

Management of dyslipidemia with statins in the patient with peripheral arterial disease. (Tech Vasc Interv Radiol. 2006)

Randomized trial of the effects of cholesterol-lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20,536 people with peripheral arterial disease and other high-risk conditions. (J Vasc Surg. 2007)

Antithrombotic treatment for peripheral arterial disease (Heart 2007) "Conclusions: Although the most favourable risk-benefit profile, cost-effectiveness and overall evidence base supports aspirin in this setting, we provide scenarios in which alternatives to aspirin should be considered."

The effect of intensified lipid-lowering therapy on long-term prognosis in patients with peripheral arterial disease. (J Vasc Surg. 2007) "CONCLUSIONS: Higher doses of statins and lower LDL cholesterol levels are both independently associated with improved outcome in patients with peripheral arterial disease. These results support the view that statins have beneficial effects beyond their lipid-lowering properties and should be considered in all patients with PAD, irrespective of LDL cholesterol levels."

Antithrombotic treatment for peripheral arterial disease (Heart 2007)

Prevention of serious vascular events by aspirin amongst patients with peripheral arterial disease: randomized, double-blind trial (Journal of Internal Medicine 2007) "Conclusions. For the first time direct evidence shows that low-dose aspirin should routinely be considered for PAD patients, including those with concomitant type 2 diabetes."

Cilostazol for peripheral arterial disease. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: Patients with IC should receive secondary prevention for cardiovascular disease. Cilostazol has been shown to be of benefit in improving walking distance in people with IC. There are no data on whether it results in a reduction of adverse cardiovascular events."

Peripheral arterial disease. Management of peripheral arterial disease in the elderly. (Geriatrics. 2007)

Exercise

The role of exercise training in peripheral arterial disease. (Vasc Med. 2007)

Supervised exercise training combined with ginkgo biloba treatment for patients with peripheral arterial disease. (Clin Rehabil. 2007) "CONCLUSION: Supervised exercise training combined with ginkgo biloba treatment did not produce greater beneficial effects than exercise training alone in patients with peripheral arterial disease."

Physical activity, walking exercise, and calf skeletal muscle characteristics in patients with peripheral arterial disease. (J Vasc Surg. 2007) "Results suggest that clinicians should encourage their patients to increase their walking activity during daily life."

[Peripheral arterial obliterative disease and physical activity.] (Orv Hetil. 2007) "Regular physical exercise represents an essential element in treating patients with second-stage peripheral arterial occlusive disease. Peripheral arterial occlusive disease is a characteristic clinical manifestation of atherothrombotic processes. Its prevalence is 2-3% … According to the data published so far, patients with peripheral arterial obliterative disease are recommended to take part in supervised treadmill walking at least 3 days per week for 30-60 minutes each session containing 5-5 minute warm-up and cool-down periods. The training should be of intermittent intensity at the pain-free threshold. The physiological benefits are optimised at 3-6 months. The home-based training programme is also remarkably useful."

Acute impairment of the endothelial function by maximal treadmill exercise in patients with intermittent claudication, and its improvement after supervised physical training. (Int Angiol. 2007) "CONCLUSIONS: Endothelial dysfunction takes a relevant part in the pathophysiology of IC, with 2/3 of the patients showing an EF lower than the pathological cut-off. Maximal exercise worsens the EF, according to the trend associated with the acute inflammatory response. All these features suggest that physical activity in IC should not utilize the maximal working load, in order to avoid the high inflammatory activation and the acute complications of atherosclerotic plaque. The supervised physical training, besides confirming itself as the most effective means to increase the walking ability, also proved to be able to improve the EF of these patients, as described about other diseases. It is probable that moderate hemodynamic stress reduces the levels of the inflammatory markers and increases the flow-mediated vasodilation through an ischemic preconditioning. The increased walking ability, associated with the improvement of EF could improve the heavy systemic outcome of claudicant patients, as it has been demonstrated in patients with coronary heart disease."

Blood pressure response to isometric exercise in patients with peripheral atherosclerotic disease. (Clin Physiol Funct Imaging. 2007) "Conclusion Our study indicates that the pressor response continues to be well regulated with age, also when the cardiovascular system is altered by marked atherosclerosis. The consequence is that both PAD patients and elderly controls reach higher SP values during isometric exercise due to higher SP baseline values."

General Information

Treatment after myocardial infarction. (Compr Ther. 2007)

Secondary Medical Prevention among Danish Patients Hospitalised with Either Peripheral Arterial Disease or Myocardial Infarction. (Eur J Vasc Endovasc Surg. 2007)

Omega-3 fatty acids for intermittent claudication. (Cochrane Database Syst Rev. 2007)

Buflomedil for intermittent claudication. (Cochrane Database Syst Rev. 2007)

Lipid-lowering for peripheral arterial disease of the lower limb. (Cochrane Database Syst Rev. 2007)

A critical review of antiplatelet treatment in peripheral arterial disease. (Intern Emerg Med. 2007)

[Therapy of chronic ischemic pain in peripheral arterial disease : A survey among physicians.] (Schmerz. 2007)

How to treat hypertension in patients with peripheral artery disease. (Curr Hypertens Rep. 2007)

Treatment for superficial thrombophlebitis of the leg. (Cochrane Database Syst Rev. 2007) "CONCLUSIONS: Low molecular weight heparin and NSAIDs appear as the current best therapeutic options for ST of the legs. While the available data are too limited to make clear recommendations, an intermediate dose of LMWH for at least a month might be advised. Further research is needed to assess the role of NSAIDs and LMWH, the optimal doses and duration of treatment, and whether a combination therapy may be more effective than single treatment. Adequately designed and conducted studies are required to clarify the role of topical and surgical treatments."

Lipid management and peripheral arterial disease. (Curr Drug Targets. 2007)

Can long-term antibiotic treatment prevent progression of peripheral arterial occlusive disease? A large, randomized, double-blinded, placebo-controlled trial. (Atherosclerosis. 2007) "CONCLUSION: Long-term treatment with roxithromycin is ineffective in preventing death, amputation, peripheral revascularization, myocardial infarction, stroke, transient cerebral ischaemic attack, thrombosis and decline in ABPI in patients with an established diagnosis of PAD."

Current endovascular treatment of peripheral arterial disease. (Prog Cardiovasc Nurs. 2007)

Therapy insight: peripheral arterial disease and diabetes--from pathogenesis to treatment guidelines. (Nat Clin Pract Cardiovasc Med. 2007) "The increased risk of atherothrombotic events present in all patients with peripheral arterial disease (PAD) is amplified with concomitant diabetes. Moreover, diabetes is associated with increased PAD severity. This Review summarizes atherothrombosis and PAD in patients with diabetes, and American College of Cardiology and American Heart Association guidelines for management of patients with PAD. Patients with PAD and diabetes require optimal limb care and aggressive cardiovascular risk reduction."