Evaluation and medical treatment of peripheral arterial disease

Current Opinion in Cardiology

Volumn 18, Issue 6, 2003, Pages 436-443

  Bashir, Riyaz ^a   Cooper, Christopher J ^a  

^a MEDICAL COLLEGE OF OHIO   (United States)

Author keywords

Angiogenesis; Critical limb ischemia; Intermittent claudication; Peripheral arterial disease

Indexed keywords

ACETYLSALICYLIC ACID; ANTITHROMBOCYTIC AGENT; CILOSTAZOL; CLOPIDOGREL; GLUTATHIONE; HEPARIN; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; HYPOCHOLESTEROLEMIC AGENT; ILOPROST; NAFTIDROFURYL; PENTOXIFYLLINE; PROSTAGLANDIN E1; UNIPROST;

ADOPTIVE IMMUNOTHERAPY; ARTERY DISEASE; BLOOD PRESSURE MONITORING; CARDIOVASCULAR RISK; CAUSE OF DEATH; COMPRESSION THERAPY; COMPUTER ASSISTED TOMOGRAPHY; COST EFFECTIVENESS ANALYSIS; DIAGNOSTIC VALUE; ECHOGRAPHY; GENE TRANSFER; HEALTH SURVEY; HUMAN; NUCLEAR MAGNETIC RESONANCE IMAGING; PREVALENCE; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; RISK ASSESSMENT; SMOKING CESSATION; SURGICAL TECHNIQUE; SURVIVAL RATE;

BRACHIAL ARTERY; HUMANS; LOWER EXTREMITY; PERIPHERAL VASCULAR DISEASES; UNITED STATES;

EID: 1342280462     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-200311000-00003     Document Type: Review

References (74)

1. Criqui MH, Langer RD, Fronek A, et al.: Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992, 326:381-386.
2. Hirsch AT, Criqui MH, Treat-Jacobson D, et al.: Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001, 286:1317-1324.
3. Belch JJ, Topol EJ, Agnelii G, et al.: Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med 2003, 163:884-892. This is a commentary of the Executive Committee of the Prevention of Atherothrombotic Disease Network citing critical issues in PAD detection and clinical management and recommending five measures to address this disorder as a significant global public health issue.
4. Dormandy JA, Rutherford RB: Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Concensus (TASC). J Vasc Surg 2000, 31:S1-S296.
5. Hiatt WR, Hirsch AT, Regensteiner JG, Brass EP: Clinical trials for claudication: assessment of exercise performance, functional status, and clinical end points. Vascular Clinical Trialists. Circulation 1995, 92:614-621.
6. Hirsch AT, Hiatt WR: PAD awareness, risk, and treatment: new resources for survival-the USA PARTNERS program. Vasc Med 2001, 6(3 Suppl):9-12.
7. Meijer WT, Hoes AW, Rutgers D, et al.: Peripheral arterial disease in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol 1998, 18:185-192.
8. Collins TC, Petersen NJ, Suarez-Almazor M, Ashton CM: The prevalence of peripheral arterial disease in a racially diverse population. Arch Intern Med 2003, 163:1469-1474. This is a study of 403 patients older than 50 years of age, showing that 13% of PAD patients are white and 13% are Hispanic, whereas 22% are African American.
9. Higgins JP, Higgins JA: Peripheral arterial disease - Part I: Diagnosis, epidemiology and risk factors. J Okla State Med Assoc 2002, 95:765-769; quiz 770-771.
10. Pradhan AD, Rifai N, Ridker PM: Soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, and the development of symptomatic peripheral arterial disease in men. Circulation 2002, 106:820-825. In this study of approximately 1500 men, an elevated level of soluble intercellular adhesion molecule-1 (sICAM-1) was independently associated with development of PAD when these patients were followed for 9 years.
11. McDermott MM, Greenland P, Green D, et al.: D-dimer, inflammatory markers, and lower extremity functioning in patients with and without peripheral arterial disease. Circulation 2003, 107:3191-3198. In this study of approximately 600 patients, elevated D-dimer levels were independently associated with poor lower extremity functioning as measured by 6-minute walking distance, 4-meter walking velocity, and summary performance score. A similar association was noted with elevated levels of hsCRP, but only in patients with PAD.
12. Van Den Bosch MA, Kemmeren JM, Tanis BC, et al.: The RATIO study: oral contraceptives and the risk of peripheral arterial disease in young women. J Thromb Haemost 2003, 1:439-444.
13. McDermott MM, Greenland P, Guralnik JM, et al.: Depressive symptoms and lower extremity functioning in men and women with peripheral arterial disease. J Gen Intern Med 2003, 18:461-467.
14. Brevetti G, Piscione F, Silvestro A, et al.: Increased inflammatory status and higher prevalence of three-vessel coronary artery disease in patients with concomitant coronary and peripheral atherosclerosis. Thromb Haemost 2003, 89:1058-1063.
15. Kurvers HA, van der Graaf Y, Blankensteijn JD, et al.: Screening for asymptomatic internal carotid artery stenosis and aneurysm of the abdominal aorta: comparing the yield between patients with manifest atherosclerosis and patients with risk factors for atherosclerosis only. J Vasc Surg 2003, 37:1226-1233.
16. Kelly R, Staines A, MacWalter R, et al.: The prevalence of treatable left ventricular systolic dysfunction in patients who present with noncardiac vascular episodes: a case-control study. J Am Coll Cardiol 2002, 39:219-224.
17. Gosk-Bierska I, Adamiec R, Szuba A: Platelets' glycoproteins and their ligands in patients with intermittent claudication. Int Angiol 2003, 22:164-171.
18. Cassar K, Bachoo P, Brittenden J: The role of platelets in peripheral vascular disease. Eur J Vasc Endovasc Surg 2003, 25:6-15.
19. Cassar K, Bachoo P, Ford I, et al.: Platelet activation is increased in peripheral arterial disease. J Vasc Surg 2003, 38:99-103. In this study of 100 patients, the platelet activation was increased in patients with intermittent claudication and critical limb ischemia as compared with control subjects. The platelet activation was measured as P-selectin expression.
20. Flex A, Gaetani E, Pola R, et al.: The -174 G/C polymorphism of the interleukin-6 gene promoter is associated with peripheral artery occlusive disease. Eur J Vasc Endovasc Surg 2002, 24:264-268.
21. Taute BM, Glaser C, Taute R, Podhaisky H: Progression of atherosclerosis in patients with peripheral arterial disease as a function of angiotensin-converting enzyme gene insertion/deletion polymorphism. Angiology 2002, 53:375-382.
22. Renner W, Pabst E, Paulweber B, et al: The angiotensin-converting-enzyme insertion/deletion polymorphism is not a risk factor for peripheral arterial disease. Atherosclerosis 2002, 165:175-178.
23. Renner W, Brodmann M, Pabst E, et al.: The V34L polymorphism of factor XIII and peripheral arterial disease. Int Angiol 2002, 21:53-57.
24. McKenna M, Wolfson S, Kuller L. The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis 1991, 87:119-128.
25. Gokce N, Keaney JF Jr, Hunter LM, et al.: Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease. J Am Coll Cardiol 2003, 41:1769-1775. This study looked at flow-mediated vasodilation of the brachial artery in 199 patients undergoing vascular surgery and followed them for an average of 1.2 years. Impaired endothelium-dependent vasodilation was noted to highly correlate with future ischemic events in these patients.
26. Komarov A, Panchenko E, Dobrovolsky A, et al.: D-dimer and platelet aggregability are related to thrombotic events in patients with peripheral arterial occlusive disease. Eur Heart J 2002, 23:1309-1316. This study of 123 patients with PAD showed that the risk of future ischemic events was significantly higher in patients with elevated D-dimer levels and low platelet aggregation, when followed over an average of 4.2 years.
27. Gerdes VE, ten Cate H, de Groot E, et al.: Arterial wall thickness and the risk of recurrent ischemic events in carriers of the prothrombin G20210A mutation with clinical manifestations of atherosclerosis. Atherosclerosis 2002, 163:135-140. This study of 277 patients demonstrated an association of prothrombin G2021OA gene mutation with carotid and femoral artery intima-media thickness (IMT) and future ischemic events in patients with atherosclerotic vascular disease.
28. Ouriel K: Peripheral arterial disease. Lancet 2001, 358:1257-1264.
29. Padberg FT, Back TL, Thompson PN, Hobson RW 2nd: Transcutaneous oxygen (TcPO2) estimates probability of healing in the ischemic extremity. J Surg Res 1996, 60:365-369.
30. Eiberg JP, Hansen MA, Jensen F, et al.: Ultrasound contrast-agent improves imaging of lower limb occlusive disease. Eur J Vasc Endovasc Surg 2003, 25:23-28. This small study showed that ultrasonographic imaging of infrapopliteal vessels is improved by using contrast agents; however, the sensitivity and specificity was still poor when compared with angiography.
31. Ofer A, Nitecki SS, Linn S, et al.: Multidetector CT angiography of peripheral vascular disease: a prospective comparison with intraarterial digital subtraction angiography. AJR Am J Roentgenol 2003, 180:719-724. This 18-patient study demonstrated a sensitivity of 91% and a specificity of 92% for detection of stenosis of greater than 50% in patients with PAD.
32. McDermott MM, Hahn EA, Greenland P, et al.: Atherosclerotic risk factor reduction in peripheral arterial disease: results of a national physician survey. J Gen Intern Med 2002, 17:895-904. This national physician survey of 405 internists, 435 family practitioners, 473 cardiologists, and 264 vascular surgeons who were randomly identified from the AMA database showed that risk factor modification and antiplatelet therapy were perceived as much more important in CAD patients than in patients with PAD. Besides this, the threshold to treat elevated cholesterol was much higher in patients with PAD than CAD, and this was particularly seen in vascular surgery group.
33. Antiplatelet therapy in peripheral arterial disease. Consensus statement. Eur J Vasc Endovasc Surg 2003, 26:1-16.
34. Roller RE, Dorr A, Ulrich S, Pilger E: Effect of aspirin treatment in patients with peripheral arterial disease monitored with the platelet function analyzer PFA-100. Blood Coagul Fibrinolysis 2002, 13:277-281. This study of 26 patients showed that 40% of PAD patients did not respond to 100 and 300 mg of aspirin as determined by collagen and epinephrine closure time using a platelet function analyser. However, it is not clear at this point whether nonresponders benefit clinically from aspirin or not.
35. Fowler B, Jamrozik K, Norman P, Allen Y: Prevalence of peripheral arterial disease: persistence of excess risk in former smokers. Aust N Z J Public Health 2002, 26:219-224.
36. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998, 317:713-720.
37. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UK-PDS 38. BMJ 1998, 317:703-713.
38. Murabito JM, Evans JC, Nieto K, et al.: Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J 2002, 143:961-965. This population-based study in approximately 1550 men and 1450 women showed that 3.9% men and 3.3% women had PAD. It showed that hypertension and smoking were the two most important modifiable risk factors that contributed to the development of PAD.
39. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991, 265:3255-3264.
40. Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin- converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145-153.
41. Mehler PS, Coll JR, Estacio R, et al.: Intensive blood pressure control reduces the risk of cardiovascular events in patients with peripheral arterial disease and type 2 diabetes. Circulation 2003, 107:753-756. This study of 950 patients showed that intensive control of blood pressure significantly reduced the incidence of ischemic events (38% to 13% in 4 years) as compared to usual blood pressure control. The blood pressure in the usual control group was 134/ 81 as compared to intensive control group of 128/75 mm Hg
42. Degischer S, Labs KH, Hochstrasser J, et al.: Physical training for intermittent claudication: a comparison of structured rehabilitation versus home-based training. Vasc Med 2002, 7:109-115. This study once again showed that structured vascular rehabilitation was significantly superior to a home-based exercise program. In this study, the home-based exercise group were given the same exercise prescription as patients in a supervised group. Interestingly, in this study the addition of clopidogrel given to patients in the supervised rehabilitation group led to improvement in absolute and initial claudication distances.
43. Gardner AW, Poehlman ET: Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA 1995, 274:975-980.
44. Gardner AW, Katzel LI, Sorkin JD, Goldberg AP: Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease: a randomized controlled trial. J Cardiopulm Rehabil 2002, 22:192-198. This study of 31 patients randomized to 6 months of vascular rehabilitation versus usual care controls showed that the beneficial effects of supervised vascular rehabilitation persisted at 18 months.
45. Ambrosetti M, Salerno M, Tramarin R, Pedretti RF: Efficacy of a short-course intensive rehabilitation program in patients with moderate-to-severe intermittent claudication. Ital Heart J 2002, 3:467-472. In this study, 4 weeks of supervised vascular rehabilitation led to 132% increase in initial claudication distance and 87% increase in absolute claudication distance in 26 patients.
46. Cote MC, Ligeti R, Cutler BS, Nelson PR: Management of hyperlipidemia in patients with vascular disease. J Vasc Nurs 2003, 21:63-67; quiz 68-69. In this study of 105 patients who were admitted for vascular surgery procedures, only 42% patients were at or below the NCEP goals for lipid levels.
47. Mukherjee D, Lingam P, Chetcuti S, et al.: Missed opportunities to treat atherosclerosis in patients undergoing peripheral vascular interventions: insights from the University of Michigan Peripheral Vascular Disease Quality Improvement Initiative (PVD-QI2). Circulation 2002, 106:1909-1912. This study of 66 patients highlights the need for quality improvement initiatives in all hospitals where patients with peripheral arterial disease are treated. This study demonstrated that less than 50% of patients were receiving evidence-based therapy with statins, ACE inhibitors, β-blockers, or antiplatelet therapy. The 6-month follow-up of these patients revealed a better outcome in patients who did receive evidence-based therapies.
48. Aronow WS, Ahn C: Elderly diabetics with peripheral arterial disease and no coronary artery disease have a higher incidence of new coronary events than elderly nondiabetics with peripheral arterial disease and prior myocardial infarction treated with statins and with no lipid-lowering drug. J Gerontol A Biol Sci Med Sci 2003, 58:573-575. This study of approximately 650 patients with PAD demonstrated that patients with CAD had a lower incidence of coronary events when they were treated with statins than patients without known CAD who were not treated with statins (55% as compared to 69%).
49. Ghosh S, Aronow WS: Utilization of lipid-lowering drugs in elderly persons with increased serum low-density lipoprotein cholesterol associated with coronary artery disease, symptomatic peripheral arterial disease, prior stroke, or diabetes mellitus before and after an educational program on dyslipidemia treatment. J Gerontol A Biol Sci Med Sci 2003, 58:M432-435.
50. McDermott MM, Guralnik JM, Greenland P, et al.: Statin use and leg functioning in patients with and without lower-extremity peripheral arterial disease. Circulation 2003, 107:757-761. This study of 392 patients with abnormal ABIs and 249 patients with normal ABIs showed that statin use was associated with better lower extremity functioning in both groups. The lower extremity functional outcomes were measured as 6-minute walk distance, 4-meter walking velocity, and summary performance score combining walking speed, standing balance, and time for five repeated chair rises.
51. Mondillo S, Ballo P, Barbati R, et al.: Effects of simvastatin on walking performance and symptoms of intermittent claudication in hypercholesterolemic patients with peripheral vascular disease. Am J Med 2003, 114:359-364. In this randomized, placebo-controlled study of 82 patients with intermittent claudication and hypercholesterolemia, the peak and maximum walking distances increased significantly more in the statin group as compared to the placebo group. Interestingly, statins produced an improvement in ABIs as well.
52. Regensteiner JG, Ware JE Jr, McCarthy WJ, et al.: Effect of cilostazol on treadmill walking, community-based walking ability, and health-related quality of life in patients with intermittent claudication due to peripheral arterial disease: meta-analysis of six randomized controlled trials. J Am Geriatr Soc 2002, 50:1939-1946. In this meta-analysis of six trials involving 1751 patients, treatment with cilostazol was associated with greater improvements in maximum walking distance, walking impairment questionnaire scores, and Medical Outcomes Study Short Form-36 scores in patients with intermittent claudication than treatment with placebo.
53. Grouse JR 3rd, Allan MC, Elam MB: Clinical manifestation of atherosclerotic peripheral arterial disease and the role of cilostazol in treatment of intermittent claudication. J Clin Pharmacol 2002, 42:1291-1298.
54. Chattaraj SC: Treprostinil sodium Pharmacia. Curr Opin Investig Drugs 2002, 3:582-586.
55. 2 analogue beraprost did not lead to any significant improvement in maximum or pain-free walking distances as compared to placebo. However, these results are in contrast to the results of two European trials that have shown efficacy of beraprost in improving these functional outcomes.
56. Toriyama T, Kumada Y, Matsubara T, et al.: Effect of artificial carbon dioxide foot bathing on critical limb ischemia (Fontaine IV) in peripheral arterial disease patients. Int Angiol 2002, 21:367-373.
57. Montori VM, Kavros SJ, Walsh EE, Rooke TW: Intermittent compression pump for nonhealing wounds in patients with limb ischemia. The Mayo Clinic experience (1998-2000). Int Angiol 2002, 21:360-366.
58. Dougherty MJ, Young LP, Calligaro KD: One hundred twenty-five concomitant endovascular and open procedures for lower extremity arterial disease. J Vasc Surg 2003, 37:316-322.
59. Stavropoulos SW, Solomon JA, Soulen MC, et al.: Use of abciximab during infrainguinal peripheral vascular interventions: initial experience. Radiology 2003, 227:657-661.
60. Lipsitz EC, Ohki T, Veith FJ, et al.: Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia? J Vasc Surg 2003, 37:386-391.
61. Shaw MB, DeNunzio M, Hinwood D, et al.: The results of subintimal angioplasty in a district general hospital. Eur J Vasc Endovasc Surg 2002, 24:524-527.
62. Hansrani M, Overbeck K, Smout J, Stansby G: Intravascular brachytherapy for peripheral vascular disease. Cochrane Database Syst Rev 2002, 4:CD003504.
63. Bonvini R, Baumgartner I, Do do D, et al: Late acute thrombotic occlusion after endovascular brachytherapy and stenting of femoropopliteal arteries. J Am Coll Cardiol 2003, 41:409-412. In this study of 94 patients who received endovascular brachytherapy of femoropopliteal arteries, late acute thrombotic occlusion was seen in 27% of patients who got stented (n = 22) and was always seen in conjunction with reduction in the antiplatelet agent clopidogrel. None of the patients who only had percutaneous transluminal angioplasty (n = 72) had late acute thrombotic occlusion.
64. Duda SH, Pusich B, Richter G, et al.: Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: six-month results. Circulation 2002, 106:1505-1509. This randomized study comparing sirolimus-coated self-expanding stents with bare self-expanding stents showed that the 6-month restenosis rate was reduced from 31% to 22% by sirolimus coating. A total of 38 patients undergoing femoropopliteal stenting were enrolled and received follow-up 6-month angiography.
65. d'Othee BJ, Haulon S, Mounier-Vehier C, et al.: Percutaneous endovascular treatment for stenoses and occlusions of infrarenal aorta and aortoiliac bifurcation: midterm results. Eur J Vasc Endovasc Surg 2002, 24:516-523.
66. Faglia E, Mantero M, Caminiti M, et al.: Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects. J Intern Med 2002, 252:225-232.
67. Razavi MK, Wong H, Kee ST, et al.: Initial clinical results of tenecteplase (TNK) in catheter-directed thrombolytic therapy. J Endovasc Ther 2002, 9:593-598.
68. Rocha-Singh KJ, Trokey J: Combined glycoprotein IIb/IIIa receptor inhibition and low-dose fibrinolysis for peripheral arterial thrombosis. Catheter Cardiovasc Interv 2002, 55:457-460.
69. Engelke C, Sandhu C, Morgan RA, Belli AM: Using 6-mm cutting balloon angioplasty in patients with resistant peripheral artery stenosis: preliminary results. AJR Am J Roentgenol 2002, 179:619-623.
70. Duda SH, Bosiers M, Pusich B, et al.: Endovascular treatment of peripheral artery disease with expanded PTFE-covered nitinol stents: interim analysis from a prospective controlled study. Cardiovasc Intervent Radiol 2002, 25:413-418.
71. Mohler ER 3rd, Rajagopalan S, Olin JW, et al.: Adenoviral-mediated gene transfer of vascular endothelial growth factor in critical limb ischemia: safety results from a phase I trial. Vasc Med 2003, 8:9-13.
72. Lederman RJ, Mendelsohn FO, Anderson RD, et al.: Therapeutic angiogenesis with recombinant fibroblast growth factor-2 for intermittent claudication (the TRAFFIC study): a randomised trial. Lancet 2002, 359:2053-2058. This is the largest angiogenesis trial to date, in which 190 patient with intermittent claudication were enrolled. It demonstrated that single-dose intra-arterial infusion of recombinant FGF produced a significant increase in peak walking distance at 90 days. However, the repeat dose at 30 days was not better than the single dose.
73. Baumgartner I, Pieczek A, Manor O, et al.: Constitutive expression of phVEGF165 after intramuscular gene transfer promotes collateral vessel development in patients with critical limb ischemia. Circulation 1998, 97:1114-1123.
74. Tateishi-Yuyama E, Matsubara H, Murohara T, et al.: Therapeutic angiogenesis for patients with limb ischaemia by autologous transplantation of bone-marrow cells: a pilot study and a randomised controlled trial. Lancet 2002, 360:427-435. In this study of 47 patients with PAD, autologous bone marrow mononuclear cell implantation led to an improvement in ABIs, pain-free walking distance, rest pain, and transcutaneous oxygen tension.