Peripheral arterial disease goals

The goals of treatment are to lower total and LDL cholesterol in order to reduce the risk of first or recurrent events such as myocardial infarction, angina, heart failure, ischemic stroke, or other forms of peripheral arterial disease such as carotid stenosis or abdominal aortic aneurysm. 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

To assess the feasibility of angiogenic cell therapy for patients with peripheral artery diseases, we organized a randomized controlled clinical trial using CDI33+ cells implanted in ischemic limbs. The goal of the study is to demonstrate that intramuscular implantation of autologous human CD 133 + cells into ischemic limbs effectively induces collateral vessel formation, improving function, and trophic ischemic lesions (79-81). 

Hirsch AT. Claudication as an orphan disease rationale and goals of drug therapy for peripheral arterial disease. Viasc Med 1996 1 37-42. 

Our goal as clinicians in the field of peripheral arterial disease should be to apply the multiple technological advances that we have toward limb salvage and the prevention of amputation. This chapter will discuss the surgical, percutaneous, and medical adjuncts available in this regard. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

PAD is a coronary artery disease risk equivalent, and a BP goal of <130/80 mm Hg is recommended. ACE inhibitors may be ideal in patients with symptomatic lower-extremity PAD CCBs may also be beneficial, p-Blockers have traditionally been considered problematic because of possible decreased peripheral blood flow secondary to unopposed stimulation of a-receptors that results in vasoconstriction. However, )5-blockers are not contraindicated in PAD and have not been shown to adversely affect walking capability. 

The rationale underlying the treatment of chronic HTN concerns its association with atherosclerosis and the increased risk of stroke, heart failure, renal diseases, peripheral vascular disease, and coronary artery disease. Except in severe HTN, there is no rash to start drug Rx prior to lifestyle changes because the goals are long term. Factors in hypertension include decreases in vagal tone, increases in sympathetic tone, increased renin-angiotensin activity, and water retention. 

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