Abstract
Peripheral arterial disease (PAD) is chronic arterial occlusive disease of the lower
extremities caused by atherosclerosis whose prevalence increases with age. Only one-half
of women with PAD are symptomatic. Symptomatic and asymptomatic women with PAD are
at increased risk for all-cause mortality, cardiovascular mortality, and mortality
from coronary artery disease. Modifiable risk factors that predispose women to PAD
include active cigarette smoking, passive smoking, diabetes mellitus, hypertension,
dyslipidemia, increased plasma homocysteine levels and hypothyroidism. With regard
to management, women who smoke should be encouraged to quit and referred to a smoking
cessation program. Hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism
require treatment. Statins reduce the incidence of intermittent claudication and improve
exercise duration until the onset of intermittent claudication in women with PAD and
hypercholesterolemia. Anti-platelet drugs such as aspirin or especially clopidogrel,
angiotensin-converting enzyme inhibitors and statins should be given to all women
with PAD. Beta blockers are recommended if coronary artery disease is present. Exercise
rehabilitation programs and cilostazol increase exercise time until intermittent claudication
develops. Chelation therapy should be avoided as it is ineffective. Indications for
lower extremity percutaneous transluminal angioplasty or bypass surgery in women are
(1) incapacitating claudication interfering with work or lifestyle; and (2) limb salvage
in women with limb-threatening ischemia as manifested by rest pain, non-healing ulcers,
and/or infection or gangrene. Future research includes investigation of mechanisms
underlying why women have a higher risk of graft failure and major amputation.
Keywords
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Article info
Publication history
Published online: October 15, 2009
Accepted:
October 2,
2009
Received:
September 27,
2009
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
