Multimodal management of chronic lower extremity ischemia
https://doi.org/10.51793/OS.2026.29.6.012
Abstract
Background. Chronic ischemia of the lower extremities, which represents the predominant manifestation of peripheral artery disease, undoubtedly represents a significant public health challenge in contemporary society due to its high prevalence, progressive course, risk of critical ischemia and major amputations, and the associated increased short-term mortality risk. The prevalence of chronic lower extremity ischemia demonstrates sex-specific patterns with an earlier onset and a slightly higher prevalence in men. However, after the age of 75, these sex differences diminish, and the prevalence of this pathology becomes higher in women.
Objective. The current review aimed to outline current approaches to the comprehensive multimodal management of peripheral arterial disease, in accordance with the level of evidence in international and national clinical guidelines.
Results. An analysis of epidemiological data, etiology, and pathogenesis of chronic lower extremity ischemia was performed, as well as its most hallmark symptom, intermittent claudication. Underlying mechanisms of disease development are described. This review evaluates a multimodal approach and current treatment trends for patients with chronic lower extremity ischemia and intermittent claudication. The review outlines the mechanisms of action, efficacy, and future therapeutic applications of cilostazol for managing patients with chronic lower extremity ischemia, as well as those with other pathologies.
Conclusion. Representing one of the manifestations of systemic cardiovascular disease, requires a personalized yet comprehensive approach involving the prescription of maintenance therapy and peripheral perfusion enhancers. Cilostazol, with the highest level of evidence, is the first-line agent for increasing pain-free walking distance in patients with intermittent claudication. The efficacy and safety of cilostazol have been demonstrated in a series of placebo-controlled studies, thereby underlying the clinical efficacy and improved quality of life in the patient cohort.
About the Authors
R. V. Akhmetzianov
Kazan State Medical University; Interregional Clinical and Diagnostic Center
Russian Federation
Russian Federation
Rustem V. Akhmetzianov, Dr. of Sci. (Med.), Associate Professor of the Department of Cardio-Vascular and Endovascular Surgery; cardiovascular surgeon of the Department of
Vascular Surgery
49 Butlerova str., Kazan, 420012
12a Karbysheva str., Kazan, 420101
D. S. Sukhanov
Saint Petersburg State Pediatric Medical University
Russian Federation
Russian Federation
Dmitriy S. Sukhanov, Dr. of Sci. (Med.), clinical pharmacologist, Associate Professor of the Department of Propaedeutics of Internal Diseases
2 Litovskaya str., Saint Petersburg, 194100
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Akhmetzianov R.V., Sukhanov D.S. Multimodal management of chronic lower extremity ischemia. Lechaschi Vrach. 2026;(6):90-98. (In Russ.) https://doi.org/10.51793/OS.2026.29.6.012
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