Lower extremity artery disease (LEAD) is a marker of a more advanced atherosclerotic process
often affecting multiple vascular beds beyond the lower limbs, with a consequent increased risk for
all-cause and cardiovascular mortality. Antithrombotic therapy is the cornerstone of management of
these patients to prevent ischaemic cardiovascular and limb events and death. In patients with symptomatic
LEAD, the efficacy of aspirin has been established long ago for the prevention of cardiovascular
events. In the current guidelines, clopidogrel may be preferred over aspirin following its incremental
ability to prevent cardiovascular events, while ticagrelor is not superior to clopidogrel in reducing cardiovascular
outcomes. Dual antiplatelet therapy (DAPT, aspirin with clopidogrel) is currently recommended
for at least 1 month after endovascular interventions irrespective of the stent type. Antiplatelet
monotherapy is recommended after infra-inguinal bypass surgery, and DAPT may be considered in
below-the-knee bypass with a prosthetic graft. In symptomatic LEAD, the addition of anticoagulant
(vitamin K antagonists) to antiplatelet therapy increased the risk of major and life-threatening bleeding
without benefit regarding cardiovascular outcomes. In a recent trial, low dose of direct oral anticoagulant
rivaroxaban plus aspirin showed promising results, not only to reduce death and major cardiovascular
events, but also major limb events including amputation. Yet, this option should be considered especially
in very high risk patients, after considering also the bleeding risk. Despite all the evidence accumulated
since >40 years, many patients with LEAD remain undertreated and deserve close attention and
implementation of guidelines advocating the use of antithrombotic therapies, tailored according to their
level of risk.
Feasibility study on retinal vascular bypass surgery in isolated arterially perfused caprine eye model
