Medical treatment of peripheral arterial disease

Purpose of review: The evolution of interventional treatments of peripheral arterial disease is progressing at a dizzying pace. However, optimized medical therapy of these patients may be neglected. Recent advances in our understanding of atherosclerosis and the epidemiology of vascular disease reemphasize the importance of a consistent and complete medical regimen. They have also opened new avenues for potential therapy. Recent findings: A diagnosis of peripheral arterial disease confers an increased risk of morbidity and mortality that can be at least partially mitigated with a properly designed medical regimen. New evidence supports the importance of risk factor modification including controlling hypertension, lowering lipid levels, and the routine use of antiplatelet agents. For claudication symptoms, several newer drugs and the use of immune-modifying therapy are showing some improvement in symptoms. The use of gene therapy and other means to achieve improved collateral formation in ischemic tissues are showing some promise in the early stages of study. Summary: Peripheral arterial disease is a marker of cardiovascular morbidity and mortality risk. An individualized plan should be devised to include smoking cessation, exercise, lowering serum lipids, lowering high blood pressure, and daily antiplatelet therapy. Supervised exercise programs and cilostazol remain the first-line medical therapies for claudication symptoms, and anticoagulants are added to patients who have bypasses at high risk for thrombosis. The utilities of immune-modifying, antibiotic, and angiogenic therapies remain to be proven.