Peripheral arterial disease(PAD)is a common atherosclerotic cardiovascular disease.The patients with this disease experience pain during exercise,which is relieved after rest.Exercise interventions,dietary interventions,and combined interventions can treat PAD via different mechanisms.Aerobic exercise,resistance exercise,and combined exercise can increase muscle strength and improve cardiorespiratory fitness to regulate vascular endothelial adhesion.Dietary interventions,such as dietary fibre,polyunsaturated fatty acids,and antioxidants,can affect plaque formation via anti-inflammatory and antioxidant mechanisms.The combined exercise and dietary interventions can have synergistic effects.This article reviews the relationship between the two interventions and PAD and describes the current status of research on different interventions,providing a scientific basis for the prevention and treatment of PAD.
Humans ; Peripheral Arterial Disease/diet therapy* ; Exercise Therapy/methods* ; Exercise/physiology* ; Diet

Peripheral artery disease (PAD) and diabetes increase the risk of significant morbidity and mortality and can affect quality of life. PAD is a progressive disease, and the presence of diabetes mellitus increases the risk of adverse outcomes among patients with PAD. Diabetes patients should undergo an initial screening for PAD that evaluates walking speed, leg fatigue, claudication, and pedal pulses. Healthcare providers should discuss with their patients controllable risk factors for PAD that can be modified. A comprehensive care plan for patients with PAD and diabetes mellitus is important and may include smoking cessation, structured exercise therapy, foot care, glycemic control and management of other cardiovascular risk factors (weight management, diet, and control of blood pressure and cholesterol). PAD with diabetes mellitus is a lifelong chronic medical condition, and prompt identification and treatment of PAD are crucial. Patient education is needed to prevent complications and to encourage a healthy and active lifestyle.
Blood Pressure ; Diabetes Mellitus ; Diet ; Education ; Exercise Therapy ; Fatigue ; Foot ; Health Education ; Health Personnel ; Humans ; Leg ; Life Style ; Mass Screening ; Mortality ; Patient Education as Topic ; Peripheral Arterial Disease ; Quality of Life ; Risk Factors ; Smoking Cessation ; Walking

BACKGROUND AND OBJECTIVES: We aimed to investigate the history of medical resource consumption and quality of life (QoL) in peripheral arterial disease (PAD) patients in Korea. METHODS: This was a prospective, multi-center (23 tertiary-hospitals, division of cardiology), non-interventional study. Adult patients (age ≥20 years) suffering from PAD for the last 12-month were enrolled in the study if they met with any of following; 1) ankle-brachial index (ABI) ≤0.9, 2) lower-extremity artery stenosis on computed tomography angiography ≥50%, or 3) peak-systolic-velocity-ratio (PSVR) on ultrasound ≥2.0. Medical chart review was used to assess patient characteristics/treatment patterns while the history of medical resource consumption and QoL data were collected using a patient survey. QoL was measured using EuroQoL-5-dimensions-3-level (EQ-5D-3L) score system, and the factors associated with QoL were analyzed using multiple linear regression analysis. RESULTS: This study included 1,260 patients (age: 69.8 years, male: 77.0%). The most prevalent comorbidities were hypertension (74.8%), hyperlipidemia (51.0%) and diabetes-mellitus (50.2%). The 94.1% of the patients took pharmacotherapy including aspirin (76.2%), clopidogrel (53.3%), and cilostazol (33.6%). The 12.6% of the patients were receiving smoking cessation education/pharmacotherapy. A considerable number of patients (500 patients, 40.0%) had visit history to another hospital before diagnosis/treatment at the current hospital, with visits to orthopedic units (50.4%) being the most common. At the time, 29% (or higher) of the patients were already experiencing symptoms of critical limb ischemia. Baseline EQ-5D index and EQ VAS were 0.64±0.24 and 67.49±18.29. Factors significantly associated with QoL were pharmacotherapy (B=0.05053; p=0.044) compared to no pharmacotherapy, and Fontaine stage improvement/maintain stage I (B=0.04448; p < 0.001) compared to deterioration/maintain stage II–IV. CONCLUSIONS: Increase in disease awareness for earlier diagnosis and provision of adequate pharmacotherapy is essential to reduce disease burden and improve QoL of Korean PAD patients.
Adult ; Angiography ; Ankle Brachial Index ; Arteries ; Aspirin ; Comorbidity ; Constriction, Pathologic ; Diagnosis ; Drug Therapy ; Extremities ; Humans ; Hyperlipidemias ; Hypertension ; Ischemia ; Korea ; Linear Models ; Male ; Orthopedics ; Peripheral Arterial Disease ; Prospective Studies ; Quality of Life ; Smoking Cessation ; Ultrasonography

The popliteal artery is a relatively short vascular structure, but acute occlusion can decrease blood flow into the lower extremities and cause subsequent critical limb ischemia, amputation, and even mortality. Further, peripheral artery disease patients frequently have combined cardio-cerebrovascular disease. Here, we report a rare case of sudden bilateral thrombotic total occlusion in the popliteal arteries of a patient with dilated cardiomyopathy and left ventricular thrombi. This patient has been successfully managed by endovascular therapy and subsequent intra-arterial thrombolytic therapy.
Amputation ; Angioplasty ; Cardiomyopathy, Dilated ; Extremities ; Humans ; Ischemia ; Lower Extremity ; Mortality ; Peripheral Arterial Disease ; Popliteal Artery ; Thromboembolism ; Thrombolytic Therapy

The ultimate objective of dyslipidemia management is to prevent and treat atherosclerotic cardiovascular diseases. It is important to combine lifestyle modification together with medication. To determine whether to start drug therapy, comprehensive consideration should be given to both the risk status for atherosclerotic cardiovascular disease and low density lipoprotein cholesterol levels. Drug treatment can be initiated according to whether the patients have coronary artery disease, ischemic cerebral infarction, peripheral artery disease, atherosclerotic artery diseases (abdominal aortic aneurysm, carotid artery stenosis), or diabetes, as well as the number of atherosclerotic risk factors (smoking, hypertension, low high density lipoprotein cholesterol level, family history of premature coronary artery disease, and age). Statin is the first-choice drug for the treatment of hypercholesterolemia. The first goal for drug therapy is to lower the low density lipoprotein cholesterol and the secondary goal is to lower the non-high density lipoprotein cholesterol level. Secondary causes of dyslipidemia should be considered and corrected before starting any medication. These recommendations are based on the new treatment guideline 2015 of Korean Society of Lipidology and Atherosclereosis and Korean Medical Association.
Aortic Aneurysm ; Arteries ; Cardiovascular Diseases ; Carotid Arteries ; Cerebral Infarction ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease ; Drug Therapy ; Dyslipidemias* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Hypertension ; Life Style ; Lipoproteins ; Peripheral Arterial Disease ; Risk Factors

OBJECTIVETo observe the effects of moxibustion and treadmill exercise on transcutaneous oxygen tension and exercise capacity in lower limbs of peripheral arterial disease (PAD).

METHODSTotally 58 mild-to-moderate PAD patients were assigned to the control group (18 cases), the moxibustion group (20 cases), and the treadmill exercise group (20 cases) by random digit table. Patients in the control group received conventional drug therapy for 12 weeks. Patients in the moxibustion group and the treadmill exercise group additionally received moxibustion [at Zusanli (ST36), Sanyinjiao (SP6), Yongquan (KI1)] and treadmill exercise respectively, once per day, 5 times per week for 12 weeks in total. Ankle-Brachial Index (ABI) , transcutaneous oxygen tension (TcPO₂), 6-min walking test (6MWT), and walking impairment questionnaire (WIQ) were assessed before and after treatment.

RESULTSCompared with the control group and the same group before treatment, there was no statistical difference in ABI in the moxibustion group and the treadmill exercise group (P > 0.05). But TcPO₂, 6MWT, and WIQ were obviously elevated (P < 0.01). Besides, 6MWT and WIQ assessment of the treadmill exercise group were better than that of the moxibustion group (P < 0.01) after intervention.

CONCLUSIONMoxibustion and treadmill exercise could improve the exercise capacity and TcPO₂of lower limbers in PAD patients.

Exercise Test ; Exercise Therapy ; Exercise Tolerance ; Humans ; Lower Extremity ; physiopathology ; Moxibustion ; Oximetry ; Oxygen ; blood ; Peripheral Arterial Disease ; therapy ; Surveys and Questionnaires ; Walking

OBJECTIVETo analyze the trends in treatments of lower extremity peripheral arterial disease and their prognosis in the recent 10 years.

METHODSClinical data of inpatients with lower extremity peripheral arterial disease who received surgical treatments in Xuanwu Hospital from January 2002 to December 2011 were analyzed retrospectively. Patients were stratified into two groups (group 1: from 2002 to 2006, group 2: from 2007 to 2011). The demographics, risk factors, clinical presentation, lesion anatomy, therapies, limb salvage and survival were observed. χ(2) test, Fisher exact test, and t test were used to compare the data between the two groups.

RESULTSFrom 2002 to 2006, 170 limbs (47.49%) underwent conventional bypass surgery, 72 limbs (20.11%) underwent endovascular interventions and the rest 116 limbs (32.40%) received stem cell treatment. While from 2007 to 2011, the percentages were 18.49%, 68.73%, 8.27%, respectively. Furthermore, gene-based drug appeared, 67 limbs (4.51%) underwent the new treatment. Former group had decreased limb salvage rates compared with latter group (87.15% vs. 93.41%, χ(2)=15.71, P=0.000). However, survival rates did not differ from the two groups (84.67% vs. 84.31%, χ(2)=0.02, P=0.880).

CONCLUSIONWith the appearance of new medical instruments and operating methods, the percentage of the patients with lower extremity peripheral arterial disease receive endovascular interventions increases, with a improved limb salvage rates.

Humans ; Ischemia ; Limb Salvage ; Lower Extremity ; pathology ; Peripheral Arterial Disease ; diagnosis ; surgery ; therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Stem Cell Transplantation ; Survival Rate ; Treatment Outcome ; Vascular Grafting ; Vascular Patency

Peripheral arterial disease (PAD) shows increasing morbidity and mortality. Clinical manifestations of PAD, such as intermittent claudication, rest pain and nonhealing ulcer, contribute to impaired quality of life, and ischemic stroke caused by PAD can be life-threatening. Unfortunately, PAD patients often receive suboptimal treatment, and pathogenesis of the disease is still unclear. Over the past decade, the evolving technology and interdisciplinary collaboration have enabled improvement of diagnosis and treatment for PAD. This review makes a brief summary of the current status and progress in genetics research on PAD, which included candidate gene studies, linkage analyses, genome-wide association studies, and applications and development prospects of epigenetics, mitochondrial DNA and other new technologies.
Animals ; DNA, Mitochondrial ; genetics ; Genetic Predisposition to Disease ; genetics ; Genome-Wide Association Study ; methods ; trends ; Genotype ; Humans ; MicroRNAs ; genetics ; Peripheral Arterial Disease ; genetics ; therapy ; Polymorphism, Single Nucleotide ; Risk Factors

Peripheral arterial occlusive disease caused by atherosclerosis can present with intermittent claudication or critical limb ischemia. Proper diagnosis and management is warranted to improve symptoms and salvage limbs. With the introduction of new techniques and dedicated materials, endovascular recanalization is widely performed for the treatment of peripheral arterial occlusive disease because it is less invasive than surgery. However, there are various opinions regarding the appropriate indications and procedure methods for interventional recanalization according to operator and institution in Korea. Therefore, we intend to provide evidence based guidelines for interventional recanalization by multidisciplinary consensus. These guidelines are the result of a close collaboration between physicians from many different areas of expertise including interventional radiology, interventional cardiology, and vascular surgery. The goal of these guidelines is to ensure better treatment, to serve as a guide to the clinician, and consequently, to contribute to public health care.
Arterial Occlusive Diseases/radiography/*therapy ; Arteries/pathology ; Endovascular Procedures/*standards ; Humans ; Intermittent Claudication/radiography/therapy ; Limb Salvage/methods ; Lower Extremity/*blood supply ; Peripheral Arterial Disease/radiography/*therapy ; *Practice Guidelines as Topic ; Republic of Korea

Peripheral arterial disease (PAD) is a common complication of Diabetes Mellitus (DM) and often culminates in amputation of the affected foot. Pseudomonas aeruginosa infections associated with PAD are difficult to treat due to their multi-drug resistance. Herein we report a 38 year old male who reported with DM, chronic kidney disease (CKD) and rest pain of the right second toe in October 2011. He underwent percutaneous transluminal angioplasty (PTA) which was unsuccessful. The gangrene of the toes worsened and amputation of the right second toe was done. Bacteriological examination showed presence of P. aeruginosa which during the course of antibiotic therapy became multi-drug resistant. Gangrene and abscess of the foot worsened and amputation of the right third toe was performed. Then autologous peripheral blood mononuclear cell (PBMNC) therapy was performed but as infection control could not still be achieved, the fourth toe was amputated. A protocol of foot bath using carbonic water, local usage of antibiotics (Polymyxin-B), and basic fibroblast growth factor (b-FGF) spray was then employed after which the infection could be controlled and improvement in vascularity of the right foot could be observed in angiography. This combined approach after proper validation could be considered for similar cases.
Abscess ; Amputation ; Angiography ; Angioplasty ; Anti-Bacterial Agents ; Baths ; Carbon ; Cell- and Tissue-Based Therapy ; Diabetes Mellitus ; Drug Resistance, Multiple ; Fibroblast Growth Factor 2 ; Fibroblast Growth Factors* ; Foot ; Gangrene* ; Humans ; Infection Control* ; Kidney Failure, Chronic* ; Limb Salvage* ; Male ; Peripheral Arterial Disease ; Pseudomonas aeruginosa ; Renal Insufficiency, Chronic ; Toes* ; Water