Reassessment of Long-Term Guideline-Directed Therapy for Peripheral Arterial Occlusive Disease in Primary Care

Peripheral arterial occlusive disease is a manifestation of systemic atherosclerosis associated with increased risks of cardiovascular events, limb complications, and mortality. Guideline-directed medical therapy, including antiplatelet agents and statins, is recommended for secondary prevention, whereas cilostazol and exercise therapy are primarily intended for symptomatic relief of claudication. We report the case of a 68-year-old man with previously diagnosed peripheral arterial occlusive disease who presented to a primary care clinic with worsening intermittent claudication while receiving cilostazol without documented antiplatelet or statin therapy. His comorbidities included hypertension, type 2 diabetes mellitus with complications, chronic kidney disease, prior ischemic stroke, and former tobacco use. Physical examination revealed diminished pulses in the affected limb and a relatively cool foot without ulceration or acute infection. Laboratory evaluation showed serum creatinine 1.44 mg/dL (reference range: 0.70-1.30 mg/dL), estimated glomerular filtration rate 49 mL/min/1.73 m² (reference range: ≥60 mL/min/1.73 m²), and glycated hemoglobin 5.7% (reference range: 4.0%-5.6%). Aspirin 100 mg daily and rosuvastatin 10 mg daily were initiated for cardiovascular risk reduction. Cilostazol was later resumed for symptomatic management, and aspirin was changed to clopidogrel because of gastrointestinal intolerance. At the fourth week follow-up, the patient reported a modest increase in walking distance, although causality could not be established. This case highlights the importance of periodic medication reconciliation, reassessment of long-term vascular risk management, and recognition that symptomatic therapy should not substitute for guideline-directed secondary prevention in patients with established peripheral arterial occlusive disease.