[Peripheral arterial disease with lower limb claudication: Medical treatment].
Whereas the complaint from a patient with intermittent arterial claudication is walking impairment, prognosis is linked to an increased risk of cardiovascular ischemic events due to the diffuse nature of the atherosclerosis. The objectives of the medical treatment therefore include improvement of walking limit, prevention of myocardial infarction, stroke and cardiovascular death, and preventive measures to avoid progression to critical lower limb ischemia. The key areas of treatment focus on smoking cessation, exercise rehabilitation, with supervised therapy if possible, cardiovascular risk prevention with antiplatelet drugs, statins and angiotensin converting enzymes, and correction of atherosclerotic risk factors with well-defined targets (LDL less than 1g/L, HDL greater than 0.4g/L, HbA(1c) less than 6.5%, brachial blood pressure less than 140/90 or 130/80mmHg in case of diabetes or renal insufficiency, body mass index less than 25kg/m(2)). Limitation or avoidance of progression to local critical ischemia requires control of atherosclerotic risk factors and proper foot care. The patient with arterial claudication needs to understand the local and general risks of arterial atherosclerotic disease, and to be involved in his/her own treatment. Obtaining patient compliance to medical care is fundamental: specific educational workshops are of great value for this.
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Médecine vasculaire, hôpital Robert-Debré, CHU de Reims, rue du Professeur-Kochman, 51092 Reims cedex, France. along@chu-reims.fr
Bui
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Journet
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Hadj Henni
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D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000150:complications / Q000188:drug therapy; D000077407:Cilostazol; D015897:Comorbidity; D048909:Diabetes Complications / Q000188:drug therapy; D004359:Drug Therapy, Combination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007383:Intermittent Claudication / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D024821:Metabolic Syndrome / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D016540:Smoking Cessation; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013777:Tetrazoles / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D016138:Walking
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D014665:Vasodilator Agents; D000077407:Cilostazol