Chapter III: Management of cardiovascular risk factors and medical therapy

Diehm, N; Schmidli, J; Setacci, C; Ricco, J-B; de Donato, G; Becker, F; Robert-Ebadi, H; Cao, P; Eckstein, H H; De Rango, P; Teraa, M; Moll, F L; Dick, F; Davies, A H; Lepäntalo, M; Apelqvist, J (2011). Chapter III: Management of cardiovascular risk factors and medical therapy. European journal of vascular and endovascular surgery EJVES, 42 Suppl 2, S33-42. London: Elsevier 10.1016/S1078-5884(11)60011-7

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Critical limb ischaemia (CLI) is a particularly severe manifestation of lower limb atherosclerosis posing a major threat to both limb and life of affected patients. Besides arterial revascularisation, risk-factor modification and administration of antiplatelet therapy is a major goal in the treatment of CLI patients. Key elements of cardiovascular risk management are smoking cessation and treatment of hyperlipidaemia with dietary modification or statins. Moreover, arterial hypertension and diabetes mellitus should be adequately treated. In CLI patients not suitable for arterial revascularisation or subsequent to unsuccessful revascularisation, parenteral prostanoids may be considered. CLI patients undergoing surgical revascularisation should be treated with beta blockers. At present, neither gene nor stem-cell therapy can be recommended outside clinical trials. Of note, walking exercise is contraindicated in CLI patients due to the risk of worsening pre-existing or causing new ischaemic wounds. CLI patients are oftentimes medically frail and exhibit significant comorbidities. Co-existing coronary heart and carotid as well as renal artery disease should be managed according to current guidelines. Considering the above-mentioned treatment goals, interdisciplinary treatment approaches for CLI patients are warranted. Aim of the present manuscript is to discuss currently existing evidence for both the management of cardiovascular risk factors and treatment of co-existing disease and to deduct specific treatment recommendations.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Diehm, Nicolas Alexander; Schmidli, Jürg and Dick, Florian

ISSN:

1078-5884

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:20

Last Modified:

17 Mar 2015 19:27

Publisher DOI:

10.1016/S1078-5884(11)60011-7

PubMed ID:

22172471

Web of Science ID:

000298517700004

URI:

https://boris.unibe.ch/id/eprint/6625 (FactScience: 211623)

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