Management of peripheral arterial disease of the lower extremities.
Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism treated in patients with peripheral arterial disease (PAD) of the lower extremities. Statins decrease the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all persons with PAD. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are (1) incapacitating claudication in persons interfering with work or lifestyle, (2) limb salvage in persons with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene, and (3) vasculogenic impotence.
Aronow
Wilbert S
WS
Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, NY 10595, USA. wsaronow@aol.com
D000800:Angioplasty, Balloon; D050197:Atherosclerosis / Q000150:complications; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015444:Exercise; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000517:prevention & control; D035002:Lower Extremity / Q000098:blood supply; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D012307:Risk Factors; D016540:Smoking Cessation; D015607:Stents; D014656:Vascular Surgical Procedures
D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors