CLAUDICATION AND IT’S APPROACH TO PRIMARY MANAGEMENT
Abstract
Peripheral artery disease (PAD) is common and associated with significant morbidity and mortality. PAD occurs in about 18 percent of persons over 70 years of age. Usually, patients who have PAD present with intermittent claudication with pain in the calf, thigh or buttock that is elicited by exertion and relieved with a few minutes of rest. The disease may also present in a subacute or acute fashion. Symptoms of ischemic rest pain, ulceration or gangrene may be present at the most advanced stage of the disease. In caring for these patients, the primary care physician should focus on evaluation, risk factor modification and exercise. Optimal primary medical management of PAD is required for each patient, irrespective of the decision regarding lower extremity revascularization. The goals include reducing cardiovascular morbidity and mortality and improving quality of life. The approach should consist of aggressive and individualized risk factor modification including smoking cessation, antiplatelet therapy, a statin, and an angiotensin-converting enzyme inhibitor. Exercise is critical for cardiovascular health and highly effective for improving claudication symptoms. Cilostazol may be considered for symptomatic treatment in certain patients. Arterial occlusive diseases, such as coronary artery disease, cerebrovascular disease and peripheral arterial disease (PAD), are common in the primary care setting. These diseases often coexist in the same patient. Treatment of these diseases, which typically affect older adults, will consume a greater percentage of health care costs as the elderly population in the Russian Federation increases.
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