I reproduce below a few points which I came across recently in an article related to the management of the peripheral artery diseases. While managing this entity we try medical therapy and if not successful may resort to surgical interference. The adverse effects of both these modes are to be noted. And also adverse effects of diagnostic procedures also covered here. I want to stress that whatever adverse effects occur in the peripheral artery disease management, also equally apply in other cardiovascular diseases. What I notice in these parts is that the number of cases of coronary artery diseases managed are many times more than the peripheral artery diseases. It does not mean that PAD is any less, but only thing is that physicians must be missing the diagnosis because of poor history taking and examination. Within a span of a decade, I have noticed that more than 100 centres capable of dealing with heart diseases have come up within one to two hours travelling distances. They work day and night and thousands of patients undergo procedural therapies. I know at the entry point patients are investigated thoroughly including the renal function tests. But what I want to know is whether they reinvestigate the patients at the time of discharge and a little later to see whether any adverse effects have been caused during the course of angiography and other therapeutic procedures.

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Adverse Effects of Medications

Antihypertensive therapy may decrease limb perfusion pressure and
potentially exacerbate symptoms of claudication or critical limb ischemia.
Aspirin and clopidogrel increase the risk of intracranial and gastrointestinal bleeding.
The most common side effects of cilostazol include headache, diarrhoea, abnormal stools,
palpitations, and dizziness; cilostazol should not be used in patients with heart failure.
Adverse effects associated with pentoxifylline include sore throat,
dyspepsia, nausea, and diarrhea.

Vascular Diagnostic Tools

Catheter-based contrast angiography is associated with a low rate of
serious adverse outcomes in individuals with normal renal function.
However, the risk of contrast-induced acute renal failure is magnified
in certain clinical groups, particularly those with diabetes and
chronic kidney disease. In general, the incidence of contrast-induced
acute renal failure is less than 3% in patients with neither diabetes
nor chronic kidney disease; 5% to 10% in those with diabetes; 10% to
20% in those with chronic kidney disease (and greater with more
advanced stages), and 20% to 50% in those with both diabetes and
chronic kidney disease.

Surgical Procedures

Surgical procedures are associated with intraoperative and
postoperative complications including an associated cardiovascular
ischemic risk and device-related complications and graft-related
complications (e.g., pseudoaneurysms, graft thrombosis, enteric
fistulas, graft infections, death) Mechanical thrombectomy devices are associated
with haemorrhage, embolization, acute occlusion, amputation

UA Mohammed