Systematic reviews and meta-analyses for more profitable strategies in peripheral artery disease

Giovanni Di Minno, Gaia Spadarella, Giovanni Cafaro, Maurizio Petitto, Roberta Lupoli, Alessandro Di Minno, Giovanni De Gaetano, Elena Tremoli

Research output: Contribution to journalArticle

Abstract

In the peripheral arteries, a thrombus superimposed on atherosclerosis contributes to the progression of peripheral artery disease (PAD), producing intermittent claudication (IC), ischemic necrosis, and, potentially, loss of the limb. PAD with IC is often undiagnosed and, in turn, undertreated. The low percentage of diagnosis (∼30%) in this setting of PAD is of particular concern because of the potential worsening of PAD (amputation) and the high risk of adverse vascular outcomes (vascular death, coronary artery disease, stroke). A Medline literature search of the highest-quality systematic reviews and meta-analyses of randomized controlled trials documents that, due to risk of bias, imprecision, and indirectness, the overall quality of the evidence concerning diagnostic tools and antithrombotic interventions in PAD is generally low. Areas of research emerge from the information collected. Appropriate treatments for PAD patients will only derive from ad-hoc studies. Innovative imaging techniques are needed to identify PAD subjects at the highest vascular risk. Whether IC unresponsive to physical exercise and smoking cessation identifi es those with a heritable predisposition to more severe vascular events deserves to be addressed. Devising ways to improve prevention of vascular events in patients with PAD implies a co-ordinated approach in vascular medicine.

Original languageEnglish
Pages (from-to)475-489
Number of pages15
JournalAnnals of Medicine
Volume46
Issue number7
DOIs
Publication statusPublished - Nov 1 2014

Keywords

  • Absolute benefits
  • Antithrombotic treatments
  • Areas of research
  • Diagnostic tools
  • Harms
  • Limitations
  • Open issues
  • Quality of the evidence

ASJC Scopus subject areas

  • Medicine(all)

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