title: Systematic reviews and meta-analyses for more profitable strategies in peripheral artery disease.
abstract: In the peripheral arteries, a thrombus superimposed on atherosclerosis contributes to the progression of peripheral artery disease (PAD), producing intermittent claudication (IC), ischemic necrosis, and, potentially, loss of the limb. PAD with IC is often undiagnosed and, in turn, undertreated. The low percentage of diagnosis (∼30%) in this setting of PAD is of particular concern because of the potential worsening of PAD (amputation) and the high risk of adverse vascular outcomes (vascular death, coronary artery disease, stroke). A Medline literature search of the highest-quality systematic reviews and meta-analyses of randomized controlled trials documents that, due to risk of bias, imprecision, and indirectness, the overall quality of the evidence concerning diagnostic tools and antithrombotic interventions in PAD is generally low. Areas of research emerge from the information collected. Appropriate treatments for PAD patients will only derive from ad-hoc studies. Innovative imaging techniques are needed to identify PAD subjects at the highest vascular risk. Whether IC unresponsive to physical exercise and smoking cessation identifies those with a heritable predisposition to more severe vascular events deserves to be addressed. Devising ways to improve prevention of vascular events in patients with PAD implies a co-ordinated approach in vascular medicine.
authors.affiliation: Department of Clinical Mediine and Surgery, Università degli Studi di Napoli , Naples , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Minno
authors.forename: Gaia
authors.initials: G
authors.lastname: Spadarella
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cafaro
authors.forename: Maurizio
authors.initials: M
authors.lastname: Petitto
authors.forename: Roberta
authors.initials: R
authors.lastname: Lupoli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Minno
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Gaetano
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives / Q000494:pharmacology; D001241:Aspirin / Q000494:pharmacology; D058070:Asymptomatic Diseases / Q000628:therapy; D000077407:Cilostazol; D000077144:Clopidogrel; D005343:Fibrinolytic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology*; D007511:Ischemia / Q000209:etiology* / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000517:prevention & control; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D011322:Primary Prevention; D012196:Review Literature as Topic; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control; D013777:Tetrazoles / Q000494:pharmacology; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin
keywords: Absolute benefits; antithrombotic treatments; areas of research; diagnostic tools; harms; limitations; open issues; quality of the evidence