Peripheral arterial disease (PAD): secondary prevention.

The prevalence of PAD rises as the population becomes increasingly older. At present, about 4.5 million citizens in Germany are estimated to be affected. In only one third of the patients intermittent claudication is found as a classical PAD marker. The course is thus predominantly asymptomatic. Consequently, careful evaluation of patients, including case history and pulse status as well as detailed recording of risk factors of atherosclerosis (chiefly smoking and diabetes mellitus), are important. When noninvasive methods of investigation is taken into account, the prevalence rises two- to three-fold. Duplex sonography with measurement of the ankle-brachial index (ABI) is a method which has so far not been used widely although it is highly accurate. Life expectancy of patients with PAD is shortened by about ten years. The prognosis is determined by the natural course of the disease in only a few patients (ischemia syndrome and/or ABI < 0.4). Patients are at much greater risk for cardiovascular and cerebrovascular incidents than of a systemic disease. Mortality is raised up to six fold by concomitant coronary heart disease. Therapy should therefore not only be designed to treat the peripheral, as well as the atherosclerosis. Like walk training under supervision, no smoking, optimal glycemic control in diabetic patients and restoration of the lipid status to normal are treatment measures that have proved to be effective. As for pharmacotherapy, the efficacy of thrombocyte aggregation inhibitors is regarded as proved, whereas many drugs targeting symptoms have yielded disappointing results in patients with intermittent claudication.