Management of intermittent claudication.

Medical management of PAD is a considerable challenge. Although patients typically present with IC, there is a substantial pool of subclinical PAD patients. PAD, whether symptomatic or not, confers a marked cardiovascular risk; with affected patients dying of heart attack or stroke, identification of index patients and aggressive medical treatment can offer health benefits far in excess of improvement in IC or related symptoms. Management of risk factors, lifestyle interventions, and pharmacologic treatment with agents to provide symptomatic relief have a central role in improving function and quality of life and slowing the progression to advanced endpoints, such as the rest pain, nonhealing ulcers, gangrene, and cardiac death. Surgical or percutaneous revascularization for aorto-iliac disease provides durable treatment for individuals with disabling symptoms. Newer treatments, such as angiogenic growth factor treatments, are being tested in clinical trials and seem promising. There are limited treatment choices for individuals with predominant infra-popliteal disease. In the future, the availability of newer stents and therapies to prevent re-stenosis may extend the applicability of endovascular treatment to difficult-to-treat infra-inguinal lesions.