Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management
Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management
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DOI：
10.4065/mcp.2010.0133
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发表时间：
2010-07-01
影响因子：
8.9
通讯作者：
Sealove, Brett A.
中科院分区：
文献类型：
--
作者：
Olin, Jeffrey W.;Sealove, Brett A.
外周动脉疾病（PAD），包括腹主动脉、髂动脉和下肢动脉的动脉粥样硬化，诊断不足，治疗不足，医学界了解甚少。PAD患者可能会出现多种问题，如跛行、缺血性静息痛、缺血性溃疡、反复住院、血运重建和肢体丧失。这可能导致生活质量差和抑郁症的高发病率。从肢体的角度来看，PAD患者的预后是有利的，因为70%至80%的患者在10年内跛行保持稳定。然而，在有症状和无症状的PAD患者中，心肌梗死、卒中和心血管死亡的发生率显著增加。踝臂指数是一个很好的筛查PAD的存在。如果计划进行血运重建，影像学检查（双功超声检查、计算机断层血管造影、磁共振血管造影、基于导管的血管造影）可提供额外的解剖信息。治疗的目标是改善症状，从而提高生活质量，降低心血管事件发生率（心肌梗死、中风、心血管死亡）。前者是通过建立一个有监督的运动计划和管理cliostazol或执行血运重建程序，如果药物治疗无效。一个全面的心血管风险调整计划（停止吸烟和控制血脂、血压和糖尿病）将有助于预防后者。
Peripheral artery disease (PAD), which comprises atherosclerosis of the abdominal aorta, Iliac, and lower-extremity arteries, is underdiagnosed, undertreated, and poorly understood by the medical community. Patients with PAD may experience a multitude of problems, such as claudication, ischemic rest pain, ischemic ulcerations, repeated hospitalizations, revascularizations, and limb loss. This may lead to a poor quality of life and a high rate of depression. From the standpoint of the limb, the prognosis of patients with PAD is favorable in that the claudication remains stable in 70% to 80% of patients over a 10-year period. However, the rate of myocardial infarction, stroke, and cardiovascular death in patients with both symptomatic and asymptomatic PAD is markedly Increased. The ankle brachial index is an excellent screening test for the presence of PAD. Imaging studies (duplex ultrasonography, computed tomographic angiography, magnetic resonance angiography, catheter-based angiography) may provide additional anatomic information If revascularization is planned. The goals of therapy are to improve symptoms and thus quality of life and to decrease the cardiovascular event rate (myocardial infarction, stroke, cardiovascular death). The former is accomplished by establishing a supervised exercise program and administering cliostazol or performing a revascularization procedure if medical therapy is ineffective. A comprehensive program of cardiovascular risk modification (discontinuation of tobacco use and control of lipids, blood pressure, and diabetes) will help to prevent the latter.