SAIMSARA Journal

Machine Generated Science • ISSN 3054-3991

Peripheral Artery Disease Treatment: Scoping Review with ☸️SAIMSARA.

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Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsarafa4dc087

Editorial note
• Last update: 2026-04-27 08:59:28
What is this paper about
PAD is not failing for lack of options — it is failing because the right options are too often used in isolation, too late, or not at all. This review shows where the strongest treatment signals truly are, from rivaroxaban-plus-aspirin and exercise therapy to IVUS-guided revascularization, and why real progress depends on combining them into one strategy.
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Evidence preview · Did you know?
Realistic vascular medicine scene showing PAD treatment planning with antithrombotic therapy and limb perfusion monitoring.

One strategy targets heart and limb risk

Did you know? Low-dose rivaroxaban plus aspirin reduced major cardiovascular and limb events versus aspirin alone; after revascularization, MACE/MALE burden fell with HR 0.85–0.86.

This makes PAD treatment more than local vessel repair: the evidence map links limb protection with systemic cardiovascular prevention.

Realistic rehabilitation scene showing a PAD patient walking on a supervised treadmill with vascular monitoring.

Exercise can compete with stenting

Did you know? In aortoiliac claudication, supervised treadmill exercise could outperform stenting for treadmill performance, while stenting improved quality of life more.

The practical message is provocative: anatomy matters, but walking goals, symptoms, and patient priorities can change the best treatment choice.

Realistic hospital discharge and medication checklist scene showing gaps in guideline-directed PAD therapy.

The evidence-to-care gap is large

Did you know? Only 47.4% of patients were discharged on full guideline-directed medical therapy after endovascular revascularization in real-world data.

The unlocked map shows where PAD care is lost: adherence, access, sex and socioeconomic disparities, diabetes, CKD, and bleeding-risk decisions.

Swipe sideways on mobile · full evidence map opens after unlock

Abstract: The aim of this paper is to synthesize current evidence regarding the risk factors, diagnostic screening tools, and therapeutic interventions for peripheral artery disease, with a focus on improving limb salvage and cardiovascular outcomes. The review utilises 3585 original studies with 35864537 total participants (topic deduplicated ΣN). The mapped evidence suggests that contemporary peripheral artery disease care is most consistently strengthened by intensive secondary prevention, structured exercise, and selective revascularization, with dual-pathway inhibition standing out as a prominent signal: low-dose rivaroxaban plus aspirin was associated with a 43% reduction in major adverse limb events and a 58% reduction in total vascular amputations in stable peripheral artery disease, while post-revascularization analyses showed hazard ratios of about 0.85 to 0.86 for ischemic event reduction. Across the broader treatment landscape, supervised and home-based exercise improved walking performance, cilostazol and statins supported symptom and event reduction, and drug-coated balloons, drug-eluting stents, intravascular lithotripsy, and intravascular ultrasound-guided intervention were repeatedly associated with better procedural or patency-related outcomes in selected anatomic settings. At the same time, the evidence map highlights that treatment benefit is strongly modified by diabetes mellitus, chronic kidney disease, frailty, bleeding risk, and major socioeconomic and sex-based disparities in access to guideline-directed care. Clinically, these findings support a multidisciplinary model in which aggressive medical therapy, exercise rehabilitation, and anatomy-specific revascularization are integrated rather than treated as competing strategies. Because much of the literature remains heterogeneous and a substantial share is observational, future research should prioritize pragmatic and phenotype-specific trials that clarify optimal antithrombotic selection, limb-specific effects of newer metabolic therapies, and implementation strategies that reduce undertreatment and inequity in peripheral artery disease care.

Keywords: Peripheral artery disease; Ankle-brachial index; Lower-extremity amputation; Revascularization; Cardiovascular risk factors; Critical limb ischemia; Secondary prevention; Major adverse limb events; Endovascular repair; Disease screening

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