Clinical considerations after endovascular therapy of peripheral artery disease

ABSTRACT

Introduction: Patients with peripheral artery disease (PAD) are at higher risk for all-cause mortality, driven by increased cardiovascular mortality rates. In this manuscript we review the literature on guideline-recommended therapies and discuss the major clinical considerations after endovascular therapy of PAD.

Areas covered: Current guidelines recommend smoking cessation, aspirin, statin, and renin-angiotensin system inhibitors in order to reduce the risk of cardiovascular and limb-related adverse events. Nonetheless, studies have shown that patients with PAD are undertreated with these important medical therapies. Additionally, there is lack in evidence regarding the most optimal follow up imaging approach for early detection of disease recurrence and re-intervention among patients undergoing endovascular therapy for PAD. We also describe the benefits of supervised walking exercise for patients with PAD that undergo revascularization procedures and are fit for such interventions.

Expert opinion: Adherence to guideline recommended medical therapy is crucial for improved outcomes in PAD management. Systematic assessment of risk-reduction interventions could help increase adherence to clinically beneficial interventions and improve the overall prognosis of patients with PAD undergoing revascularization procedures. Additionally, optimization of current follow up protocols is needed, with the optimal goal to develop standardized cost-effective algorithms regarding early detection of disease recurrence and re-intervention.

KEYWORDS:

• Peripheral artery disease
• PAD
• endovascular therapy
• endovascular revascularization
• EVT

Article highlights box

• PAD patients are underdiagnosed and undertreated

• Optimized medical therapy and risk factor modification with/without supervised training programs could reduce cardiovascular and limb-related risk

• The multiple risk-reduction therapies and smoking cessation have an additive clinical benefit

• Adherence to guideline recommended medical therapy is crucial for improved outcomes in PAD management

• Duplex U/S within the first six months post-procedurally could detect patients at risk for re-occlusion

• Clinical examination and ABI measurements are recommended as screening modalities for long-term follow up after EVT for PAD

• Supervised walking exercise should be strongly encouraged for patients with PAD that undergo EVT and are fit for such interventions

• Systematic assessment of risk-reduction interventions could help increase adherence to clinically beneficial interventions and improve the overall prognosis of patients with PAD undergoing revascularization procedures

Declaration of interest

E Armstrong is a consultant to Abbott Vascular, Boston Scientific, Cardiovascular Systems Incorporated (CSI), Intact Vascular, Medtronic, Philips, and PQ Bypass. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.