From the Guidelines
Peripheral artery disease (PAD) management should prioritize a combination of lifestyle modifications, medical therapies, and potentially revascularization procedures to improve symptoms, prevent progression, and reduce cardiovascular risk, as recommended by the most recent guidelines 1. The goal of treatment is to alleviate symptoms, improve quality of life, and reduce the risk of major adverse cardiovascular events and major adverse limb events.
- Lifestyle modifications are crucial and include:
- Complete smoking cessation
- Regular exercise, such as supervised exercise programs or home-based walking exercise, aiming for at least 30-45 minutes of walking 3-5 times weekly 1
- A heart-healthy diet
- Medical therapies should be prescribed to prevent major adverse cardiovascular events and major adverse limb events, including:
- Antiplatelet therapy, such as aspirin 75-100mg daily or clopidogrel 75mg daily, to prevent clotting
- Statins, such as atorvastatin 40-80mg or rosuvastatin 20-40mg daily, to lower cholesterol and stabilize plaques
- For hypertensive patients, blood pressure should be controlled to below 140/90 mmHg using ACE inhibitors or ARBs
- Rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin (81 mg daily) is effective in preventing major adverse cardiovascular events and major adverse limb events for patients with PAD 1
- For diabetic patients, tight glucose control is essential with a target HbA1c below 7%
- Severe cases may require revascularization procedures like angioplasty, stenting, or bypass surgery
- Regular foot care and inspection are important to prevent complications, especially in diabetics These interventions work by improving blood flow, preventing atherosclerosis progression, reducing inflammation, and minimizing risk factors that contribute to arterial damage and cardiovascular events. Detection of PAD in most patients is accomplished through the history, physical examination, and resting ankle-brachial index, and health disparities in PAD must be addressed at the individual patient and population levels 1.
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. Patients with chronic occlusive arterial disease of the limbs frequently show other manifestations of arteriosclerotic disease Pentoxifylline has been used safely for treatment of peripheral arterial disease in patients with concurrent coronary artery and cerebrovascular diseases
Pentoxifylline is indicated for the treatment of intermittent claudication on the basis of chronic occlusive arterial disease of the limbs, which is a manifestation of peripheral artery disease. The drug can improve function and symptoms but is not intended to replace more definitive therapy. Pentoxifylline has been used safely for treatment of peripheral arterial disease in patients with concurrent coronary artery and cerebrovascular diseases 2 2.
- Key points:
- Pentoxifylline is used to treat intermittent claudication
- The drug improves function and symptoms of peripheral artery disease
- It is not a replacement for more definitive therapy, such as surgical bypass
- Pentoxifylline can be used in patients with concurrent coronary artery and cerebrovascular diseases
From the Research
Definition and Risk Factors
- Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis, with modifiable risk factors including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity 3.
- Patients with PAD often have coexistent coronary or cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke, and cardiovascular death 3.
Diagnosis and Management
- Early and ongoing diagnosis and treatment is required for PAD, with lifestyle modifications able to prevent or delay disease progression and improve symptoms 4.
- A multidisciplinary approach to diagnosis and management, including collaboration between family practice and primary care physicians, specialists, and other healthcare professionals, can provide optimal care for patients with PAD 4.
- Medical therapies, including smoking cessation, lipid-lowering drugs, optimal glucose control, and antithrombotic medications, can reduce the risk of major adverse cardiovascular events and major adverse limb events, and improve function in patients with PAD 3.
Treatment Options
- Exercise training and cilostazol can improve walking capacity in patients with PAD 3, 5, 6.
- Antiplatelet drugs, such as aspirin or clopidogrel, can reduce the risk of cardiovascular events in patients with PAD, although aspirin may be less effective in PAD patients than in those with coronary artery disease 7.
- Statins can reduce the incidence of intermittent claudication and improve exercise duration in patients with PAD and hypercholesterolemia 5, 6.
- Indications for lower-extremity angioplasty or bypass surgery include incapacitating claudication, limb salvage, and vasculogenic impotence 5, 6.