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92 Peripheral Vascular Disease

effects of cilastazol are headache diarrhea, dizziness
and palpitation. It should be taken 30 minutes before
or 2 hours after a meal. Cilastazole is contraindicat-
ed in systolic dysfunction and heart failure of any
severity .
4
PENTOXIFYLLINE: a methylxanthine derivative is ap-
proved by FDA for treatment of claudication however
it is less effective than Cilastazol. The possible mech-
anism of action include antiplatelet effects, lowering
of plasma fibrinogen and improving the deformity of
red blood cells and white blood cells. It gives a 12%
improvement n maximal treadmill walking distance.
ACC/AHA guidelines recommend its usage as a
second line agent after cilastazol if it fails or is not
tolerated.
NAFTIDROFURYL: is a 5-hydroxytryptamine-2 recep- Bypass grafting is done with prosthetic grafts or au-
tor agonist that may act by improving muscle me- togenous vein grafts. The various Bypass surgeries
tabolism, glucose uptake, and increasing ATP levels done are aorto-femoral Bypass, Fem-Pop Bypass
in skeletal muscle. TASC II recommends the use of and fem-fem cross over Bypass. The Bypass grafts
Naftidrofuryl at a dose of 600 mg/day for treatment have a patency rate of 70 to 80% at 5 years.
of claudication.
References
ENDOVASCULAR INTERVENTIONS 1. Hiatt WR. Sealove BA, Peripheral artery disease and claudication. N Engl

Clear indications for PAD patients who need revascu- J Med 2001:344(21):1068-21.
larization are 1) Chronic limb ischemia as evidenced 2. Leng GC, Fowkers FG. The Edinburgh Claudication Questionnaire: an im-
by rest pain, non healing ulcers or gangrene. 2) Acute proved version of the WHO/Rose Questionnaire for use in epidemiological
limb ischemia with threat to limb. 3) severe claudica- survey. J Clin Epidemio1 1992;45(0):1101-9.
tion that interferes with lifestyle and a trial of exercise 3. Rose G, McCartney P, Reid DD. Self-administration of a question-
and pharmacotherapy has failed. TASC II has classi- naire on chest pain and intermittent claudication. Br. J Prev Soc Med
1977;31(1):42-8.
fied Aorto-illiac and Femoro-popliteal lesions into 4
types Type A,B,C and D : Fig.5 4. Pande RL, Hiatt WR, Zhang P, et al. A pooled analysis of the durability and
predictors of treatment response of cilostazol in patients with intermittent
Endovascular interventions is the preferred mode of respond of claudication. Vasc Med 2010;15(3):181-8.
treatment for Type A and B lesions, where as Type C 5. Sanjay Rajagopalan, Michael H. Crawford . Cardiol Clin 29(2011) 319-
and D lesions are best sent for surgical revasculariza- 329.
tion. The last decade has seen an unprecedent role
of new device development for the treatment of PAD
like cryoplasty, excimer laser, excisional atherecto-
my, sub-intimal reentry,

crosser catheters, front runner, drug eluting stents,
covered stents, cutting balloons and embolic protec-
tion devices have given us the albeit to treat a vast
array of lesions .
5
SURGICAL INTERVENTIONS
Surgical Intervention is done only for acute limb isch-
emia, chronic limb ischemia and very rarely, patients
with claudication. The two choices for surgical revas-
cularization are Endarterectomy and Bypass grafting
Fig.6

GCDC 2017