Medical Management of Peripheral Arterial Disease.

Peripheral arterial disease is a condition associated with high rates of cardiovascular morbidity and mortality, increased risk of adverse limb events, including development of critical limb ischemia and amputation, and also with decreased quality of life. This manuscript provides an overview of the medical management of patients with peripheral arterial disease. We discuss contemporary therapies that decrease major adverse cardiovascular and limb events among patients with peripheral arterial disease, and also therapies that improve the patient's ability to walk and quality of life in general.

Evaluation of the patient who presents with critical limb ischemia: diagnosis, prognosis, and medical management.

Patients with critical limb ischemia usually have severe atherosclerotic disease and are at a high risk of limb loss as well as major adverse cardiovascular events. The current article provides a description of the clinical presentation of patients with critical limb ischemia and also discusses the initial evaluation of these patients, including physical examination, use of noninvasive vascular tests, and other imaging modalities. An overview of the general management of these patients is also provided, including the identification of patients who benefit from revascularization or primary amputation, principles of wound care, and therapies for cardiovascular risk reduction.

Patient-specific antiplatelet therapy.

Platelets are key players in thrombosis, and have thus become the main targets in the acute treatment of, as well as in the primary and secondary prevention against, thrombotic cardiovascular diseases. Three main classes of anti-platelet agents are currently available for clinical use: aspirin, the thienopyridines, and the intravenous GPIIb/IIIa antagonists. While these therapies are beneficial in the mean patient population, they may produce adverse effects in selected patient subgroups.

Platelet-monocyte complex formation: effect of blocking PSGL-1 alone, and in combination with alphaIIbbeta3 and alphaMbeta2, in coronary stenting.

Background: Binding of platelet P-selectin to P-selectin glycoprotein ligand 1 (PSGL-1) is an initial event in the interactions between platelets and monocytes. Platelet-monocyte complexes (PMCs) have been implicated in several vascular disease processes, including acute coronary syndromes (ACS) and complications after percutaneous coronary intervention (PCI). We investigated the effect of ex vivo blockade of PSGL-1, alone and in combination with blockade of the alphaMbeta(2) (Mac-1) and alpha(IIb)beta(3) (GP IIb/IIIa) integrins, on PMC formation.

Arterial thrombosis for the interventional cardiologist: from adhesion molecules and coagulation factors to clinical therapeutics.

Arterial thrombosis is the result of a complex and well-orchestrated set of events where interactions between platelets and leukocytes are intertwined with enzymatic reactions of the coagulation system. Here, we present a contemporary panorama of arterial thrombosis and provide a framework the interventionalist can use to understand the current antithrombotic pharmacotherapies and recognize the role of therapies that have yet to be developed. We analyze thrombosis in the context of plaque rupture and vascular injury and describe the interactions between platelets and the subendothelium.