A New Algorithm to Treat Patients with Peripheral Vascular Disease

Peripheral vascular disease (PVD) consists of vascular disease outside of the coronary bed. Atherosclerosis is the dominant cause of PVD. Patients with PVD carry high mortality and morbidity due to increased incidence of stroke and myocardial infarction in these patients. Management of PVD should include risk factor reduction for atherosclerosis. Patients who continue to be symptomatic or continue to progress in disease severity despite optimal medical therapy may need revascularization. We describe a new proposal of algorithm (mnemonics) ABCDE aiming to prevent PVD.

ABCDE of Peripheral Vascular Disease Prevention

A: Anti-platelets

  1. Aspirin
  • Peripheral arterial disease
  • Coronary artery disease
  • Men >60 years 
  • Women >50 years
  • Transient ischemia attack 
  • Cerebrovascular accident
  1. Clopidogrel
  • Myocardial infarction
  • Transient ischemia attack
  • Cerebrovascular accident 
  • Critical limb ischemia
  1.  Cilostozol
  • Claudication

B1: Beta Blockers

  1. Congestive heart failure
  2. Myocardial infarction

B2: Blood Pressure

  1. All hypertensive patients are preferably treated with angiotensin converting enzyme (ACE) inhibitors first.
  2. Encourage diuretic to be first line of management.

C1: Cholesterol Management

  1. Myocardial infarction
  2. Transient ischemia attack
  3. Cerebrovascular accident
  4. Peripheral arterial disease with LDL >100
  5. Transient ischemia attack

C2: Cessation of Tobacco

  1. Active cigarette smoking
  • Counseling by trained tobacco cessation specialists
  1. Chewing tobacco/Pipe smoking
  • Refer to primary care physician for pharmacological intervention

D2: Diet counseling: All diet counseling by dietician, physician, and physician extenders. 

  1. Hypertension
  • Low salt diet, high fiber
  1. Diabetes mellitus
  • American diabetic association diet
  1. Hypercholesterolemia
  • Low cholesterol, high fiber diet
  1. Obesity/Overweight/Based on BMI
  • Low cholesterol, low fat diet
  • Referral to weight loss program

E1: Exercise: Specific counseling by physicians, physician extenders, and exercise physiologists.

  1. All PAD patients
  • Exercise for a minimum of 30 minutes 3 to 5 times per week
  1. Patients with claudication
  • Supervised exercise program
  • Home claudication walk log book
  • Pedometer or walking meter

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