Every PACE Counts
Learning About Blood Cells and Blood Flow in Peripheral Artery Disease
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Article, see p 1417
In our care of patients with peripheral artery disease (PAD), the fundamental goal is to “walk more, suffer less.” More than 200 million people worldwide have PAD.1 Patients with PAD experience limb ischemia leading to claudication, disability, and risk of amputation. Available therapies to enhance limb function remain inadequate. Even with optimal medical therapy, including cilostazol and supervised exercise intervention, many patients with PAD experience declining walking ability.2 Revascularization with surgical or endovascular approaches may restore function but carries procedural risks and may have limited durability. Thus, considerable need exists for novel approaches to treat limb symptoms in PAD.
Obstructive atherosclerotic lesions precipitate limb ischemia in PAD. However, available evidence indicates that the generation of claudication symptoms is more complex.3 Hemodynamic compromise measured by the ankle-brachial index correlates poorly with symptom severity and is not changed along with improvements in walking ability induced by exercise intervention. Animal models of PAD suggest that insufficient microvascular flow contributes to limb ischemia. The concept of a therapy to promote vascular growth remains an appealing therapeutic strategy to help patients with …