Document Detail


Management of infrapopliteal peripheral arterial occlusive disease.
MedLine Citation:
PMID:  22249766     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
The management of infrapopliteal peripheral arterial occlusive disease (PAD) is challenging. For patients with asymptomatic disease or claudication, exercise and optimal medical management, including antiplatelet agents, blood pressure control, statin therapy and tight glucose control for patients with diabetes mellitus, are the mainstays of therapy. However, patients with isolated tibial artery occlusive disease often have diabetes mellitus or renal insufficiency and present with critical limb ischemia (CLI). CLI is advanced occlusive disease marked by the development of rest pain, ischemic ulceration, or gangrene and is associated with a high mortality rate. Limb salvage requires an intervention in cases of CLI, but careful operative planning is required as patients often have multilevel disease and limited options for revascularization. A surgical bypass with a vein graft remains the best treatment for infrapopliteal PAD, especially in patients with a life expectancy of over 2 years. Balloon angioplasty can play an important role in limb salvage, especially for patients lacking adequate vein for bypass, at high operative risk, or with a life expectancy of less than 2 years. However, a lack of rigorous trials has left unanswered questions as to the efficacy of infrapopliteal angioplasty with or without stents compared to bypass surgery. As such, endovascular therapy is currently not a proven treatment for intermittent claudication. Patients who are unable to undergo a revascularization procedure for infrapopliteal CLI have few options besides amputation or palliation. New therapies, such as drug-eluting stents, drug-coated balloons, and stem cell therapy are under development, but their efficacy and effectiveness remain unproven.
Authors:
Warren J Gasper; Sara J Runge; Christopher D Owens
Related Documents :
22077726 - Autonomic dysfunction in ischemic stroke with carotid stenosis.
21723076 - Relationship between ankle brachial index and arterial remodeling in pseudoxanthoma ela...
22091386 - Clinical outcome of intra-arterial embolization for treatment of patients with pelvic t...
21680086 - Large middle cerebral artery dissecting aneurysm mimicking hemorrhagic stroke.
7994096 - Tactics and techniques of aortic arch replacement.
10201056 - Transcatheter embolization of pulmonary arteriovenous malformations in rendu-osler-webe...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  14     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-16     Completed Date:  2012-10-02     Revised Date:  2013-07-25    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  136-48     Citation Subset:  -    
Affiliation:
Department of Surgery, Division of Vascular Surgery, University of California San Francisco, 400 Parnassus Ave, , Box 0222, San Francisco, CA, 94143-0222, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Classic 18.5- and 21.5-kDa myelin basic protein isoforms associate with cytoskeletal and SH3-domain ...
Next Document:  Evaluation of the Single Yeast Cell's Adhesion toITO Substrates With Various Surface Energies via ES...