Peripheral arterial occlusive disease: magnetic resonance imaging and the role of aggressive medical management.
Atherosclerosis accounts for most peripheral arterial occlusive disease (PAD). Although many of the risk factors for atherosclerotic coronary artery disease (CAD) such as hyperlipidemia have been identified as risk factors for peripheral arterial disease, strong evidence is lacking that risk factor modification is effective in halting progression or improving outcomes. A better understanding is needed regarding the clinical and pathophysiologic responses to risk factor modification. This review describes current advances in the medical management for PAD including lipid modification antiplatelet therapy, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, exercise, and endovascular intervention. In addition, we discuss our active ELIMIT Trial (Effect of Lipid Modification on Peripheral Arterial Disease after Endovascular Intervention). We test the hypothesis that an aggressive regimen of serum lipid modification will inhibit the progression of atherosclerosis in femoral arteries and reduce the incidence of restenosis of femoral arteries following endovascular stenting by decreasing thrombosis and inflammation. This study will provide a novel strategy for retarding or preventing progression of atherosclerosis and re-stenosis of peripheral arterial disease following arterial revascularization procedures. Importantly, our magnetic resonance imaging studies will provide quantitative data on the vascular lesions in PAD. These studies will advance our understanding of the molecular mechanisms of inflammation and thrombosis associated with aggressive lipid modification.
Lumsden
Alan B
AB
Methodist DeBakey Heart Center, Baylor College of Medicine, 1709 Dryden Street, Suite 1500, Houston, Texas 77030, USA. alumsden@bcm.tmc.edu
Rice
Terry W
TW
Chen
Changyi
C
Zhou
Wei
W
Lin
Peter H
PH
Bray
Paul
P
Morrisett
Joel
J
Nambi
Vijay
V
Ballantyne
Christie
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000628:therapy*; D050197:Atherosclerosis / Q000175:diagnosis* / Q000628:therapy*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D005081:Exercise Therapy; D005263:Femoral Artery / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors