Management of lower extremity peripheral arterial disease

Andrew Gardner, Zhar Afaq

Research output: Contribution to journalReview article

54 Citations (Scopus)

Abstract

Peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis, is a significant health problem. It manifests in lower extremities as intermittent claudication, limb ischemia, or gangrene and other locations as stroke, renal failure, or mesenteric ischemia. Fontaine and Rutherford classifications are the 2 commonly used classifications to stage the severity of PAD. The diagnostic tools include ankle-brachial index, a valuable tool in diagnosing lower extremity PAD, and a treadmill test. Other useful diagnostic tools include the San Diego Claudication Questionnaire to screen patients for symptoms and imaging modalities such as duplex scan, angiogram, computer tomographic angiogram, and magnetic resonance angiogram. Medical management of PAD involves comprehensive care, including risk factor modification of etiologies predisposing to atherosclerosis. These involve using antiplatelet therapy with aspirin or clopidogrel, controlling hypertension, managing hypercholesterolemia, and using vasodilators such as cilostazol. Exercise rehabilitation is an efficacious approach to improve intermittent claudication and should be recommended to each patient. Revascularization therapy is indicated for those who have critical limb ischemia or severe claudication not improved by medical management. Revascularization consists of endovascular techniques to open up the vessel and traditional bypass surgery to bypass the diseased segment. Recent published guidelines detailing recommendations on different treatment modalities in patients with PAD are described.

Original languageEnglish (US)
Pages (from-to)349-357
Number of pages9
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Volume28
Issue number6
DOIs
StatePublished - Nov 1 2008

Fingerprint

Peripheral Arterial Disease
Lower Extremity
Intermittent Claudication
Angiography
clopidogrel
Atherosclerosis
Ischemia
Extremities
Exercise Therapy
Ankle Brachial Index
Endovascular Procedures
Gangrene
Hypercholesterolemia
Vasodilator Agents
Exercise Test
Aspirin
Renal Insufficiency
Magnetic Resonance Spectroscopy
Therapeutics
Stroke

All Science Journal Classification (ASJC) codes

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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Management of lower extremity peripheral arterial disease. / Gardner, Andrew; Afaq, Zhar.

In: Journal of Cardiopulmonary Rehabilitation and Prevention, Vol. 28, No. 6, 01.11.2008, p. 349-357.

Research output: Contribution to journalReview article

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