Ouriel K
Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Lancet. 2001 Oct 13;358(9289):1257-64. doi: 10.1016/S0140-6736(01)06351-6.
Lower extremity peripheral arterial disease (PAD) most frequently presents with pain during ambulation, which is known as "intermittent claudication". Some relief of symptoms is possible with exercise, pharmacotherapy, and cessation of smoking. The risk of limb-loss is overshadowed by the risk of mortality from coexistent coronary artery and cerebrovascular atherosclerosis. Primary therapy should be directed at treating the generalised atherosclerotic process, managing lipids, blood sugar, and blood pressure. By contrast, the risk of limb-loss becomes substantial when there is pain at rest, ischaemic ulceration, or gangrene. Interventions such as balloon angioplasty, stenting, and surgical revascularisation should be considered in these patients with so-called "critical limb ischaemia". The choice of the intervention is dependent on the anatomy of the stenotic or occlusive lesion; percutaneous interventions are appropriate when the lesion is focal and short but longer lesions must be treated with surgical revascularisation to achieve acceptable long-term outcome.
下肢外周动脉疾病（PAD）最常见的症状是行走时疼痛，即“间歇性跛行”。通过运动、药物治疗和戒烟，症状可能会有所缓解。与并存的冠状动脉和脑血管动脉粥样硬化导致的死亡风险相比，肢体丧失的风险相形见绌。主要治疗应针对全身性动脉粥样硬化进程，控制血脂、血糖和血压。相比之下，当出现静息痛、缺血性溃疡或坏疽时，肢体丧失的风险就会大幅增加。对于这些患有所谓“严重肢体缺血”的患者，应考虑进行球囊血管成形术、支架置入术和外科血管重建等干预措施。干预措施的选择取决于狭窄或闭塞病变的解剖结构；当病变为局限性且较短时，经皮介入治疗是合适的，但较长的病变必须通过外科血管重建来治疗，以获得可接受的长期效果。
