A contemporary approach to peripheral arterial disease

Peripheral arterial disease: Pathophysiology, risk factors, diagnosis, treatment, and prevention

Peripheral Artery Disease (PAD) is a strong predictor of MI, stroke and death due to vascular causes. PAD affects 8-12 million people in the United States. As the population lives longer with chronic diseases, researchers estimate that the incidence of PAD will increase, likely increasing myocardial infarction, stroke and death. This paper reviews the epidemiology, pathophysiology, risk factors, treatment and management of PAD. With improved understanding of the disease process, risk factors and treatment, clinicians will be able to detect PAD earlier, provide diagnosis, treat and manage this disease. PAD is associated with reduced quality of life, and persons with PAD are also at risk of developing coronary artery disease and cerebrovascular disease. Better clinical evaluation and routine screening are important in identifying and treating patients at risk for PAD. All patients with PAD should receive risk-factor modification, such as treatment and education, about smoking cessation, blood pressure control and lowering of cholesterol. Appropriate pharmacological management includes antiplatelet therapy of aspirin, use of clopidogrel for those individuals who are sensitive to aspirin. Patients who have had bypass surgery or stent placement require dual antiplatelet therapy of aspirin and clopidogrel. The American Heart Association (AHA) states that treatment with beta-blockers and ACE inhibitors is appropriate pharmacotherapy to treat PAD. Other FDA approved medications such as Cilostazol and Pentoxifylline are also used in the treatment of pain associated with intermittent claudication.

Percutaneous interventions

The catheterization laboratory is no longer limited to coronary arterial interventions. Physicians have been striving to make more interventions less invasive that now can include carotid, renal, and peripheral arterial stenting, as well as less invasive repair of atrial septal abnormalities. Even cardiac assist devices can be implanted percutaneously to bridge a critically ill patient to other modes of treatment. This article will give a brief overview of each intervention and identify important nursing care.