title: Optimal management of infrainguinal arterial occlusive disease.
abstract: Peripheral arterial occlusive disease is becoming a major health problem in Western societies as the population continues to age. In addition to risk of limb loss, the complexity of the disease is magnified by its intimate association with medical comorbidity, especially cardiovascular and cerebrovascular disease. Risk factor modification and antiplatelet therapy are essential to improve long-term survival. Surgical intervention is indicated for intermittent claudication when a patient's quality of life remains unacceptable after a trial of conservative therapy. Open reconstruction and endovascular revascularization are cornerstone for limb salvage in patients with critical limb ischemia. Recent advances in catheter-based technology have made endovascular intervention the preferred treatment approach for infrainguinal disease in many cases. Nevertheless, lower extremity bypass remains an important treatment strategy, especially for reasonable risk patients with a suitable bypass conduit. In this review, we present a summary of current knowledge about peripheral arterial disease followed by a review of current, evidence-based medical and surgical therapy for infrainguinal arterial occlusive disease.
authors.affiliation: Division of Vascular and Endovascular Surgery, Louisiana State University Health Shreveport, Shreveport, LA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Pennywell
authors.affiliation: Division of Vascular and Endovascular Surgery, Louisiana State University Health Shreveport, Shreveport, LA, USA.
authors.forename: Tze-Woei
authors.initials: TW
authors.lastname: Tan
authors.affiliation: Division of Vascular and Endovascular Surgery, Louisiana State University Health Shreveport, Shreveport, LA, USA.
authors.forename: Wayne W
authors.initials: WW
authors.lastname: Zhang
mesh_terms: D000671:Amputation, Surgical; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016638:Critical Illness; D057510:Endovascular Procedures; D019317:Evidence-Based Medicine; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D002317:Cardiovascular Agents
keywords: claudication; critical limb ischemia; endovascular infrainguinal intervention; infrainguinal bypass; peripheral arterial disease; peripheral vascular disease