How are patients with peripheral artery disease currently managed?

The overarching aims of the treatment of peripheral artery disease (PAD) are to reduce symptoms and to improve prognosis.1,2 The management of PAD includes lifestyle modifications, medical therapies and, in some instances, revascularization to:

  • Improve limb symptoms
  • Limit further progression of atherosclerosis through the control of cardiovascular (CV) risk factors
  • Prevent potentially fatal ischaemic events
  • Minimize tissue loss/need for amputation

Because of the systemic nature of the underlying disease, a multidisciplinary approach is warranted to establish an effective management strategy.1-3

Management of limb symptoms

Patients with PAD typically present with leg pain (e.g. intermittent claudication) and this can limit their daily activities and impact on their quality of life.3 Management of limb symptoms involves:

  • A supervised and structured exercise programme
  • Medical therapies aimed at reducing limb symptoms by suppressing platelet aggregation and promoting vasodilation1,3

If no improvements in limb symptoms are seen after 3–6 months of conservative therapy (CV risk factor control, structured exercise programme and medical therapy for limb symptoms), revascularization may be considered.1,2

CV risk factor control

The control of CV risk factors is essential to limit further progression of the underlying atherosclerosis causal to PAD. Key interventions include:1-3

  • Smoking cessation advice and support
  • Lifestyle changes promoting lipid, blood pressure and diabetes control (e.g. regular physical exercise, adopting a healthy diet, and following a weight-management programme)
  • Use of medical therapies aiding lipid, blood pressure and diabetes control (e.g. statins, antihypertensives and insulin/glycaemic-control medication)

Protection against cardiovascular events

Prevention of major CV events is achieved by pharmacological or lifestyle interventions that reduce plaque progression, stabilize plaques (by reducing inflammation) and prevent thrombosis, should plaque rupture or erosion occur.4

For protection against major CV events, all patients with symptomatic PAD should receive:1-3

  • Single antiplatelet therapy with acetylsalicylic acid (ASA), or clopidogrel as an alternative in case of ASA intolerance
  • A statin to reduce blood low-density lipoprotein (LDL) levels

In patients with PAD and hypertension, antihypertensive agents are also recommended to reduce blood pressure.1-3

Tissue loss minimization/​amputation avoidance

Between 10–21% of patients with intermittent claudication may experience worsening of disease and develop critical limb ischaemia,5,6 which is associated with chronic ischaemic rest pain, non-healing wounds/ulcers and gangrene.1 In these patients, as well as in patients with acute limb ischaemia and a salvageable limb, revascularization is indicated to minimize tissue loss/avoid amputation. Amputation may become necessary in some patients with irreversible tissue damage.1,2

G.MKT.GM.XA.08.2017.1707

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