Chronic arterial insufficiency of the lower limbs: Therapeutic approach

Chronic arterial insufficiency of the lower limbs is characterized by intermittent claudication often localized to the calf. These early clinical symptoms are the results of the atherosclerotic process of the vasculature of the lower extremities. The treatment is aimed at reducing or eliminating the ischemic pain and at preventing progression of the atherosclerotic disease. Whether surgical or nonsurgical measures are used, the cornerstone of patient care lies in correction of the risk factors. Smoking cessation and exercise therapy remain the fundamental measures in medical treatment of intermittent claudication. Percutaneous transluminal angioplasty is an appropriate therapeutic option under certain criteria, especially for the iliac arteries. In the absence of randomized studies, surgery remains the treatment of choice for peripheral revascularization in presence of limb-threatening ischemia or ischemic ulcers. New procedures and materials are presently under trial to test the safety and efficacy of alternative methods or revascularization that would provide better long-term patency rates and shorter hospitalization periods.