Clinical Trials within U.S.: Peripheral Vascular Disease

Amish N. Raval

LOWER—EXTREMITY PERIPHERAL ARTERY disease (PAD) is a common, debilitating, and potentially life—threatening illness affecting nearly 10 million people in the United States and fully 10 percent of those older than 60 years. PAD unfortunately remains an underrecognized disease, however, and can be difficult to treat. Obstructive PAD is most commonly caused by atherosclerosis and can initially manifest as intermittent claudication, defined as leg muscle pain with walking that is relieved with rest. PAD may progress to critical limb ischemia (CLI), defined by pain at rest, skin ulcers, and gangrene. In the latter condition, limb amputation is threatened unless blood flow can be restored. Risk factor modification, exercise therapy, and antiplatelet, antihypertensive, and antilipid therapy are mainstay therapy for PAD. Unfortunately, a significant number of patients fail medical therapy. Mechanical revascularization includes invasive surgical bypass and minimally invasive cath—eter-based approaches. Surgical bypass to restore blood flow may be limited by arteries ...

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