Document Detail


Management of peripheral arterial disease of the lower extremities in elderly patients.
MedLine Citation:
PMID:  14999033     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The prevalence of peripheral arterial disease (PAD) increases with age. PAD in elderly persons may be asymptomatic, may be associated with intermittent claudication, or may be associated with critical limb ischemia. Other atherosclerotic vascular disorders, especially coronary artery disease (CAD), may coexist with PAD. Elderly persons with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from CAD. Modifiable risk factors should be treated in persons with PAD such as cessation of cigarette smoking and control of hypertension, dyslipidemia, and diabetes. Statins have been shown to reduce the incidence of intermittent claudication and to improve treadmill exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, should be administered to all persons with PAD. Persons with PAD should be treated with angiotensin-converting enzyme inhibitors and also with beta blockers if CAD is present. Cilostazol should be given to persons with intermittent claudication to improve exercise capacity unless heart failure is present. Exercise rehabilitation programs improve exercise time until claudication. Indications for lower extremity angioplasty, preferably with stenting, or bypass surgery are 1) incapacitating claudication in persons interfering with work or lifestyle; 2) limb salvage in persons with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and 3) vasculogenic impotence. However, amputation should be performed if tissue loss has progressed beyond the point of salvage, if surgery is too risky, if life expectancy is very low, or if functional limitations obviate the benefit of limb salvage.
Authors:
Wilbert S Aronow
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The journals of gerontology. Series A, Biological sciences and medical sciences     Volume:  59     ISSN:  1079-5006     ISO Abbreviation:  J. Gerontol. A Biol. Sci. Med. Sci.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-03-04     Completed Date:  2004-04-09     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9502837     Medline TA:  J Gerontol A Biol Sci Med Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  172-7     Citation Subset:  AIM; IM    
Affiliation:
Divisions of Cardiology and Geriatrics, Department of Medicine, New York Medical College, Valhalla, USA. WSAronow@aol.com
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Amputation
Angioplasty, Balloon / methods
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Arterial Occlusive Diseases / diagnosis*,  epidemiology,  therapy*
Combined Modality Therapy
Exercise Therapy
Female
Humans
Lower Extremity
Male
Peripheral Vascular Diseases / diagnosis*,  epidemiology,  therapy*
Platelet Aggregation Inhibitors / therapeutic use
Prognosis
Risk Assessment
Severity of Illness Index
Survival Analysis
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Platelet Aggregation Inhibitors; 0/Vasodilator Agents

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