Modern strategy to improve remote results of surgical treatment of peripheral artery disease

Svetlikov A.V.^1,2, Ishpulaeva L.E.¹

1) Department of Vascular Surgery, North-Western District Scientific Clinical Centre named after L.G. Sokolov under the Federal Biomedical Agency of the Russian Federation,
2) Department of Cardiovascular Surgery, North-Western State Medical University named after I.I. Mechnikov under the RF Ministry of Public Health, Saint Petersburg, Russia

Treatment of patients presenting with peripheral artery disease requires a comprehensive approach: correction of risk factors, drug therapy and, if necessary, an endovascular/hybrid/open intervention. Reconstructive operation may effectively improve a patient’s quality of life in intermittent claudication, save the limb and life in case of severe ischaemia. Discussed in the article are advantages and disadvantages of various types of surgical interventions for peripheral artery disease, the concept PLAN (Patient risk, Limb severity, and ANatomic complexity) and the new Global Anatomic Staging System (GLASS). Good remote results may be ensured by adequate medicamentous therapy. Variations of antithrombotic therapy are versatile and debatable. Long-term dual antithrombotic or systemic anticoagulant therapy with administration of vitamin K antagonists are not indicated for peripheral artery disease. In this connection, the findings of the COMPASS and VOYAGER PAD studies are analysed. The VOYAGER PAD trial showed that in patients with peripheral artery disease who underwent revascularization of lower limbs, the addition of rivaroxaban at a dose of 2.5 mg twice daily to aspirin decreased the risk of lower-extremity unfavourable ischaemic events and major adverse cardiovascular events by 15%. The obtained findings open new possibilities of conservative therapy having a significant role in decreasing the risk for development of limb-threatening conditions.

KEY WORDS: peripheral artery disease, atherosclerosis obliterans, COMPASS, VOYAGER PAD, GLASS, PLAN, rivaroxaban, aspirin, bypass grafting, endovascular angioplasty, stenting.

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