RISK FACTORS:(Cigarette smoking and hypertension are most closely linked with worsening claudication symptoms), Smoking, Diabetes mellitus, Hypertension, Hypercholesterolemia, Family history, Obesity, Preexisting heart disease
GENERAL MEASURES:
β’ Medical treatment
β’ Elimination of risk factors whenever possible
β’ Smoking cessation
β’ Dietary optimization (low fat and low cholesterol diet)
β’ Exercise (however, approximately 70% of claudicants will require medication for symptom control)
SURGICAL MEASURES : (Note: Most patients do not require surgical management.)
β’ Angioplasty
β’ Arterial bypass surgery
DIET: Low fat, low cholesterol diet for avoidance and control of hyperlipidemia
PATIENT EDUCATION :
β’ Primary prevention: Encourage an exercise program, no smoking, healthy dietary choices, management of
blood glucose in diabetic patients, hypertension control
β’ Secondary prevention: As above. Emphasize smoking cessation and hypertension control.
DRUG(S) OF CHOICE :
β’ Aspirin - 80 mg qd to reduce platelet aggregation
β’ Pentoxifylline (Trental) - to decrease internal configuration of red cells - 400-800 mg bid-tid. Administer for at
least 6-8 weeks to determine if therapy is effective.
β’ Cilostazol (Pletal) 50-100 mg bid
CONTRAINDICATIONS :
β’ Cilostazol is contraindicated in patients with congestive heart failure
β’ Pentoxifylline is contraindicated in patients with recent cerebral and/or retinal hemorrhage
ALTERNATIVE DRUGS:
β’ Ticlopidine (Ticlid)
β’ Vasodilators
β’ Calcium channel blockers
β’ Anticoagulants
β’ Role of PGE1 and PGI2 analogues and stimulants (i.e., AS-103, iloprost, beraprost, defi brotide) continues to be investigated
PATIENT MONITORING: Peripheral noninvasive vascular studies every 6 months. If worsening, would be indication for surgery.
PREVENTION/AVOIDANCE:
. Walking program
. Avoid smoking
POSSIBLE COMPLICATIONS
. Tissue/ limb loss- predominantly affects diabetic patients as disease progresses
. Complications of reperfusion
. Compartmental syndrome
. Venous thrombosis induced by low flow state which may flush to right side of heart to pulmonary circulation
EXPECTED COURSE/PROGNOSIS :
. Gradual improvement with use of medical therapy/walking program and diminution/elimination of risk factors.
Some patients may require revascularization. Disease progression may include rest pain, tissue loss and gangrene. . Chronic intermittent ischemia may cause lasting defects in muscle function resulting in weakness which could be an early sign of peripheral arterial disease