Peripheral Arterial Insufficiency: A Comprehensive Review of Revascularization Surgery Benefits
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Abstract
Peripheral Arterial Insufficiency (PAI) is a common condition characterized by reduced blood flow to the extremities, leading to symptoms such as claudication, pain, and non-healing wounds. Revascularization surgery, including procedures like angioplasty and bypass grafting, has emerged as a cornerstone in the management of PAI, offering significant improvements in symptoms, quality of life, and limb salvage rates. This review aims to provide a comprehensive overview of PAI, including its pathophysiology, diagnostic modalities, and medical management. Additionally, the review highlights the various revascularization techniques available, their indications, outcomes, and the evolving role of endovascular interventions. Understanding the benefits and limitations of revascularization surgery is crucial for optimizing the care of patients with PAI and reducing the burden of this debilitating disease.
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References
I. Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham JP, Abubakar I, Abu-Raddad LJ, et al; GBD 2013 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.Lancet. 2015; 386:2145–91.
II. Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult U.S. population.Diabetes Care. 2019; 42:50–54. doi: 10.2337/dc18-1380
III. Elbadawi A, Elgendy IY, Saad M, Elzeneini M, Megaly M, Omer M, Banerjee S, Drachman DE, Aronow HD. Contemporary revascularization strategies and outcomes among patients with diabetes with critical limb ischemia: insights from the National Inpatient sample.JACC Cardiovasc Interv. 2021; 14:664–674. doi: 10.1016/j.jcin.2020.11.032
IV. Creager MA, Matsushita K, Arya S, Beckman JA, Duval S, Goodney PP, Gutierrez JAT, Kaufman JA, Joynt Maddox KE, Pollak AW, Pradhan AD, Whitsel LP; American Heart Association Advocacy Coordinating C. Reducing Nontraumatic lower-extremity amputations by 20% by 2030: time to get to our feet: a policy statement from the American Heart Association.Circulation. 2021; 143:e875–e891. doi: 10.1161/CIR.0000000000000967
V. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, et al; American Heart Association Council on Epidemiology; Prevention Statistics Committee; Stroke Statistics Subcommittee. Heart disease and stroke statistics-2020 update: a report from the American Heart Association.Circulation. 2020; 141:e139–e596. doi: 10.1161/CIR.0000000000000757
VI. Diehm C, Allenberg JR, Pittrow D, Mahn M, Tepohl G, Haberl RL, Darius H, Burghaus I, Trampisch HJ; German Epidemiological Trial on Ankle Brachial Index Study Group. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease.Circulation. 2009; 120:2053–2061.
doi: 10.1161/CIRCULATIONAHA.109.865600
VII. Qamar A, Morrow DA, Creager MA, Scirica BM, Olin JW, Beckman JA, Murphy SA, Bonaca MP. Effect of vorapaxar on cardiovascular and limb outcomes in patients with peripheral artery disease with and without coronary artery disease: Analysis from the TRA 2°P-TIMI 50 trial.Vasc Med. 2020; 25:124–132. doi: 10.1177/1358863X19892690
VIII. Kaplovitch E, Eikelboom JW, Dyal L, Aboyans V, Abola MT, Verhamme P, Avezum A, Fox KAA, Berkowitz SD, Bangdiwala SI, et al. Rivaroxaban and aspirin in patients with symptomatic lower extremity peripheral artery disease: a subanalysis of the COMPASS Randomized Clinical Trial.JAMA Cardiol. 2021; 6:21–29.
doi: 10.1001/jamacardio.2020.4390
IX. Jones WS, Baumgartner I, Hiatt WR, Heizer G, Conte MS, White CJ, Berger JS, Held P, Katona BG, Mahaffey KW, et al; International Steering Committee and Investigators of the EUCLID Trial. Ticagrelor compared with clopidogrel in patients with prior lower extremity revascularization for peripheral artery disease.Circulation. 2017; 135:241–250.
doi: 10.1161/CIRCULATIONAHA.116.025880
X. Hiatt WR, Bonaca MP, Patel MR, Nehler MR, Debus ES, Anand SS, Capell WH, Brackin T, Jaeger N, Hess CN, et al. Rivaroxaban and aspirin in peripheral artery disease lower extremity revascularization: impact of concomitant clopidogrel on efficacy and safety.Circulation. 2020; 142:2219–2230.
doi: 10.1161/CIRCULATIONAHA.120.050465
XI. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, et al. Peripheral arterial disease detection, awareness, and treatment in primary care.JAMA. 2001; 286:1317–1324. doi: 10.1001/jama.286.11.1317
XII. Diehm C, Schuster A, Allenberg JR, Darius H, Haberl R, Lange S, Pittrow D, von Stritzky B, Tepohl G, Trampisch HJ. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study.Atherosclerosis. 2004; 172:95–105. doi: 10.1016/s0021-9150(03)00204-1
XIII. Grøndal N, Søgaard R, Lindholt JS. Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial).Br J Surg. 2015; 102:902–906. doi: 10.1002/bjs.9825
XIV. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease.Circ Res. 2015; 116:1509–1526. doi: 10.1161/CIRCRESAHA.116.303849