Peripheral arterial occlusive disease: magnetic resonance imaging and the role of aggressive medical management.

Abstract

Atherosclerosis accounts for most peripheral arterial occlusive disease (PAD). Although many of the risk factors for atherosclerotic coronary artery disease (CAD) such as hyperlipidemia have been identified as risk factors for peripheral arterial disease, strong evidence is lacking that risk factor modification is effective in halting progression or improving outcomes. A better understanding is needed regarding the clinical and pathophysiologic responses to risk factor modification. This review describes current advances in the medical management for PAD including lipid modification antiplatelet therapy, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, exercise, and endovascular intervention. In addition, we discuss our active ELIMIT Trial (Effect of Lipid Modification on Peripheral Arterial Disease after Endovascular Intervention). We test the hypothesis that an aggressive regimen of serum lipid modification will inhibit the progression of atherosclerosis in femoral arteries and reduce the incidence of restenosis of femoral arteries following endovascular stenting by decreasing thrombosis and inflammation. This study will provide a novel strategy for retarding or preventing progression of atherosclerosis and re-stenosis of peripheral arterial disease following arterial revascularization procedures. Importantly, our magnetic resonance imaging studies will provide quantitative data on the vascular lesions in PAD. These studies will advance our understanding of the molecular mechanisms of inflammation and thrombosis associated with aggressive lipid modification.

• Authors: Alan B Lumsden, Terry W Rice, Changyi Chen, Wei Zhou, Peter H Lin, Paul Bray, Joel Morrisett, Vijay Nambi, Christie Ballantyne
• Journal: World journal of surgery (World J Surg) Vol. 31 Issue 4 Pg. 695-704 (Apr 2007) ISSN: 0364-2313 [Print] United States
• PMID: 17345122 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Platelet Aggregation Inhibitors

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Algorithms
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Arterial Occlusive Diseases (diagnosis, therapy)
• Atherosclerosis (diagnosis, therapy)
• Clinical Trials as Topic
• Disease Progression
• Exercise Therapy
• Femoral Artery (pathology)
• Humans
• Magnetic Resonance Imaging (methods)
• Peripheral Vascular Diseases (diagnosis, therapy)
• Platelet Aggregation Inhibitors (therapeutic use)
• Risk Factors