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Contemporary Medical Management of Peripheral Arterial Disease

  • Invited Review Article
  • Published:
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Abstract

Purpose

Peripheral arterial disease (PAD) is characterized by atherosclerotic arterial occlusive disease of the lower extremities and is associated with an increased risk of major adverse cardiovascular events (MACE) in addition to disabling clinical sequelae, including intermittent claudication and chronic limb-threatening ischemia (CLTI). Given the growing burden of disease, knowledge of modern practices to prevent MACE and major adverse limb events (MALE) is essential. This review article examines evidence for medical management of PAD and its associated risk factors, as well as wound prevention and care.

Methods

A thorough review of the literature was performed, with attention to evidence for the management of modifiable atherosclerotic risk factors, claudication symptoms, wound prevention, and wound care.

Results

Contemporary management of PAD requires a multi-faceted approach to care, with medical optimization of smoking, hypertension, hyperlipidemia, and diabetes mellitus. The use of supervised exercise therapy for intermittent claudication is highlighted. The anatomic disease patterns of smoking and diabetes mellitus are discussed further, and best practices for diabetic foot ulcer prevention, including offloading footwear, are described. Quality wound care is essential in this patient population and involves strategic use of debridement, wound-healing adjuncts, and skin substitutes, when appropriate.

Conclusion

The objective of medical management of PAD is to reduce the risk of MACE and MALE. Atherosclerotic risk factor optimization, appropriate wound care, and management of diabetic foot ulcers, foot infections, gangrene, and chronic, non-healing wounds are critical components of PAD care. Interdisciplinary care is essential to coordinate care, leverage expertise, and improve outcomes.

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Data Availability

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Code Availability

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Abbreviations

PAD:

Peripheral arterial disease

CLTI:

Chronic limb-threatening ischemia

CLI:

Critical limb ischemia

IC:

Intermittent claudication

CAD:

Coronary artery disease

CKD:

Chronic kidney disease

ESRD:

End-stage renal disease

HD:

Hemodialysis

DM:

Diabetes mellitus

MACE:

Major adverse cardiovascular event

MALE:

Major adverse limb event

ABI:

Ankle-brachial index

AHA:

American Heart Association

SVS:

Society for Vascular Surgery

ACC:

American College of Cardiology

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  1. Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX, 77030, USA

    Ian O. Cook & Jayer Chung

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Both Dr. Cook-Armstrong and Dr. Jayer Chung contributed equally to the writing and the critical revisions and concept of the manuscript. There were no statistical analyses undertaken for the manuscript. There was no appropriation of funding for the manuscript. Dr. Chung assumes ultimate responsibility for the integrity of the work.

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Cook, I.O., Chung, J. Contemporary Medical Management of Peripheral Arterial Disease. Cardiovasc Drugs Ther (2023). https://doi.org/10.1007/s10557-023-07516-2

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