Q: My 57 years old father is suffering from PVD with stenosis and the doctor has advised that surgical intervention may not be required. I have consulted two more doctors. One doctor also felt that no surgical procedure would be required and prescribed Trental 400 mg twice daily, EcoAspirin daily, Pentop daily and Atorlip 10 daily. The other doctor prescribed Zilast. We shared with him that the patient is not comfortable with Zilast, so he changed it to Trental 400 twice daily and prescribed Zocor 20 mg daily and Deplatt A daily. Which medications should he take? Is Cilostazol better than Trental 400 in treating PVD?

A:I feel it would be inadvisable for us to conduct a case conference on the net for a particular patient suffering from PVD with Iliac involvement. We do not have whole information and also are dependent on the clinical picture assessed by other clinicians. In my reply to the original query I tried to set out the guiding principles of the management of the PVD citing the patient in question as an example. I have to add that I did not rule out surgical treatment, which remains an option but only when medical treatment and endovascular treatment have been tried. I have to also add that Trental, which has been in use for almost four decades, has not been very useful in modifying the disease or relieving the symptoms. The best medical treatment still remains to be troika of:

1. Antiplatlet therapy.
2. Anticholesterol drugs.
3. And above all active exercise regime, also not ignoring the controlling of the risk factors.