Endovascular Intervention for Peripheral Artery Disease
Endovascular Intervention for Peripheral Artery Disease
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DOI：
10.1161/circresaha.116.303503
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发表时间：
2015-04-24
影响因子：
20.1
通讯作者：
Kinlay, Scott
中科院分区：
文献类型：
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作者：
Thukkani, Arun K.;Kinlay, Scott
在过去的十年中，血管内治疗的进展扩大了经皮治疗周围血管疾病的选择。对于许多有多种合并症的患者，血管内治疗是一种风险较低的开放手术选择。在血管内介入治疗之前进行无创生理检查和动脉成像，有助于定位疾病和计划手术。血运重建的时机和需要与跛行、重度肢体缺血和急性肢体缺血这三种主要临床表现广泛相关。许多跛行患者可以通过运动和药物治疗来治疗。当血管内手术不能改善患者的生活质量和功能时，应考虑进行血管内手术。相比之下，重度肢体缺血和急性肢体缺血对肢体构成威胁，需要更紧急的血运重建。一般来说，血管内治疗对于髂主动脉疾病比股腘窝疾病具有更长的长期持久性。膝下血运重建术通常用于危急和急性肢体缺血。球囊血管成形术和支架置入术是血管内治疗的主要方法。新的经过良好测试的创新包括药物洗脱支架和药物涂层气球。辅助装置用于穿越慢性全闭塞或动脉粥样硬化切除术后的减积斑块的研究较少，并且具有小众的作用。接受血管内手术的患者需要一个结构化的随访护理监测计划。这包括加强心血管危险因素的治疗，以预防心肌梗死和中风，这是死亡的主要原因。肢体监测的目的是识别再狭窄和受干预节段以外的新疾病，这两种疾病都可能危及通畅并导致复发症状、功能损害或肢体受到威胁。
Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb.