What are the initial management recommendations for Peripheral Vascular Disease (PVD)?

From the Guidelines

Initial management of Peripheral Vascular Disease (PVD) should focus on lifestyle modifications, medical therapy, and risk factor control, with a priority on statin therapy to achieve an ultimate LDL-C goal of <1.4 mmol/L (55 mg/dL) and a >50% reduction in LDL-C vs. baseline, as recommended by the 2024 ESC guidelines 1. The management plan should include:

• Quitting smoking immediately to reduce disease progression
• Regular exercise, such as supervised walking programs for 30-45 minutes at least 3 times weekly, to improve claudication symptoms and walking distance
• Dietary changes emphasizing low saturated fat, low cholesterol, and increased fiber intake
• Antiplatelet therapy with aspirin (75-325 mg daily) or clopidogrel (75 mg daily) to reduce cardiovascular events
• Blood pressure control to less than 140/90 mmHg, with ACE inhibitors or ARBs preferred
• Diabetes management with a target HbA1c below 7%
• Foot care, including daily inspection, proper footwear, regular podiatry visits, and prompt attention to wounds These interventions aim to reduce symptoms, slow disease progression, and decrease the risk of limb loss and cardiovascular events by improving peripheral circulation, reducing inflammation, and preventing atherosclerotic plaque formation and thrombosis. Key aspects of PVD management also include:
• The use of cilostazol (100 mg twice daily) to improve walking distance in patients with claudication
• The consideration of revascularization for symptomatic arterial territories, using the least invasive strategy in a multidisciplinary vascular team approach
• The importance of individualized HbA1c targets according to comorbidities, diabetes duration, and life expectancy in patients with diabetes
• The recommendation to avoid hypoglycaemia in patients with PVD
• The consideration of SGLT2 inhibitors and GLP-1 receptor agonists with proven CV benefit in patients with type 2 diabetes and PVD.

From the FDA Drug Label

Pentoxifylline Extended-Release Tablets are indicated for the treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease of the limbs. Pentoxifylline Extended-Release Tablets can improve function and symptoms but is not intended to replace more definitive therapy, such as surgical bypass, or removal of arterial obstructions when treating peripheral vascular disease.

The initial management recommendations for Peripheral Vascular Disease (PVD) include:

• Improving function and symptoms with medications like pentoxifylline [ 2 ]
• Considering more definitive therapy, such as:
  • Surgical bypass
  • Removal of arterial obstructions Pentoxifylline is not intended to replace these more definitive therapies when treating PVD.

From the Research

Initial Management Recommendations for Peripheral Vascular Disease (PVD)

The initial management of PVD involves a combination of lifestyle modifications, medical therapies, and potentially, surgical interventions.

• Lifestyle modifications include:
  • Smoking cessation 3, 4, 5, 6
  • Exercise rehabilitation programs 3, 4, 5, 6
  • Dietary modification 5
• Medical therapies include:
  • Statins to reduce the incidence of intermittent claudication and improve exercise duration 3, 4, 6
  • Antiplatelet drugs such as aspirin or clopidogrel to reduce cardiovascular events 3, 4, 5, 6
  • Angiotensin-converting enzyme inhibitors 3
  • Beta blockers for patients with coronary artery disease 3
  • Cilostazol to increase exercise time until intermittent claudication develops 3, 4
  • Pentoxifylline to improve walking distance 7
• Surgical interventions may be considered for:
  • Incapacitating claudication that interferes with work or lifestyle 3
  • Limb salvage in patients with limb-threatening ischemia 3, 4, 5
  • Vasculogenic impotence 3
  • Revascularization with percutaneous or surgical therapy for patients with rest limb ischemia or ulceration 4, 5