2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease
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2016年AHA/ACC关于下肢周围动脉疾病患者的治疗指南
DOI：
10.1016/j.jacc.2016.11.007
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发表时间：
2017-03-21
影响因子：
24
通讯作者：
Walsh, M. Eileen
中科院分区：
文献类型：
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作者：
Gerhard-Herman, Marie D.;Gerhard-Herman, Marie D.;Walsh, M. Eileen
本指南中列出的建议尽可能以证据为基础。2015年1月至9月进行了初步广泛的证据审查，包括来自涉及人类受试者的研究的文献，以英语发表，并在MEDLINE（通过PubMed）、EMBASE、科克伦图书馆、医疗保健研究和质量管理局以及与本指南相关的其他选定数据库中检索。关键检索词包括但不限于：急性肢体缺血、血管成形术、踝臂指数、抗凝、抗血小板治疗、非典型腿部症状、血压降低/高血压、旁路移植术/旁路移植术/外科搭桥术、西洛他唑、跛行/间歇性跛行、严重肢体缺血/严重肢体缺血、糖尿病、诊断测试、血管内治疗，运动康复/运动疗法/运动训练/监督运动、下肢/足部伤口/溃疡、外周动脉疾病/外周动脉疾病/外周血管疾病/下肢动脉疾病、吸烟/戒烟、他汀类药物、支架植入术和血管手术。在指南编写过程中，编写委员会还考虑了截至2016年9月发表的其他相关研究，并在适当时添加到证据表中。在线数据补充中包含的最终证据表总结了编写委员会用于制定建议的证据。此外，编写委员会审查了ACC和AHA先前发表的下肢外周动脉疾病（PAD）相关文件（9，10）。本文件中选择和发表的参考文献具有代表性，并非包罗万象。如前言所述，ACC/AHA指南方法规定委托独立的ERC解决系统性综述问题（PICOTS格式），为编写委员会制定的建议提供信息。所有其他指南建议（不基于系统综述问题）也经过了广泛的证据审查过程。对于本指南，编写委员会与工作组和ERC主席一起确定了以下系统性综述问题：1）抗血小板治疗是否有利于预防有症状或无症状下肢PAD患者的心血管事件？2)与最佳药物治疗和运动训练相比，血运重建对跛行患者的功能结局和生活质量（QoL）有何影响？每一个问题都是最近出版的，系统的
The recommendations listed in this guideline are, whenever possible, evidence based. An initial extensive evidence review, which included literature derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline, was conducted from January through September 2015. Key search words included but were not limited to the following: acute limb ischemia, angioplasty, ankle-brachial index, anticoagulation, antiplatelet therapy, atypical leg symptoms, blood pressure lowering/hypertension, bypass graft/bypass grafting/surgical bypass, cilostazol, claudication/intermittent claudication, critical limb ischemia/severe limb ischemia, diabetes, diagnostic testing, endovascular therapy, exercise rehabilitation/exercise therapy/exercise training/supervised exercise, lower extremity/foot wound/ulcer, peripheral artery disease/peripheral arterial disease/peripheral vascular disease/lower extremity arterial disease, smoking/smoking cessation, statin, stenting, and vascular surgery. Additional relevant studies published through September 2016, during the guideline writing process, were also considered by the writing committee, and added to the evidence tables when appropriate. The final evidence tables included in the Online Data Supplement summarize the evidence utilized by the writing committee to formulate recommendations. Additionally, the writing committee reviewed documents related to lower extremity peripheral artery disease (PAD) previously published by the ACC and AHA (9, 10). References selected and published in this document are representative and not all-inclusive. As stated in the Preamble, the ACC/AHA guideline methodology provides for commissioning an independent ERC to address systematic review questions (PICOTS format) to inform recommendations developed by the writing committee. All other guideline recommendations (not based on the systematic review questions) were also subjected to an extensive evidence review process. For this guideline, the writing committee in conjunction with the Task Force and ERC Chair identified the following systematic review questions: 1) Is antiplatelet therapy beneficial for prevention of cardiovascular events in the patient with symptomatic or asymptomatic lower extremity PAD? 2) What is the effect of revascularization, compared with optimal medical therapy and exercise training, on functional outcome and quality of life (QoL) among patients with claudication? Each question has been the subject of recently published, systematic