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The medical therapy of intermittent claudication is founded on two fundamental precepts (Table 34-1). The most compelling of these is that peripheral arterial disease is evidence for systemic atherosclerosis. Affected patients most likely have concomitant coronary artery and cerebrovascular diseases. As a result, they are at increased risk for adverse clinical outcomes including myocardial infarction, stroke, and death. These patients also frequently manifest symptoms of intermittent claudication, resulting in impaired functional status, or symptoms of critical limb ischemia—rest pain, ulcers, or gangrene, which ultimately threaten the viability of the limb. Therefore, management of these patients must employ therapeutic strategies that decrease their risk of cardiovascular events, reduce mortality, improve functional capacity and quality of life, and preserve limb integrity. In contrast to the relative intangibility of vascular risk reduction, symptomatic improvement in peripheral arterial disease after the institution of appropriate medical therapy can often become apparent to the patient within a matter of weeks or a few months and can significantly enhance a patient's quality of life.

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TABLE 34-1.Pharmacological Treatment for Intermittent Claudication

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