Hiatt William R
Department of Medicine, University of Colorado School of Medicine, c/o Colorado Prevention Center, 789 Sherman Street, Suite 200, Denver, CO 80203, USA.
J Vasc Surg. 2002 Dec;36(6):1283-91. doi: 10.1067/mva.2002.129654.
Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis that is associated with a high risk of cardiovascular mortality and significant limitation in function because of limb ischemia. Patients with PAD should be considered to have significant coronary and cerebral arterial disease that requires aggressive risk factor management, including the prescription of antiplatelet drugs, to lower the subsequent risk of myocardial infarction, stroke, and death. In the population with PAD, level 1 and level 2 evidence supports the use of statin drugs for lipid management, angiotensin-converting enzyme-1 inhibitors for blood pressure control, and aspirin or clopidogrel as antiplatelet agents. Once this is accomplished, the severity of limb symptoms should be assessed, and a structured exercise program or the selected use of drugs such as cilostazol to treat claudication should be prescribed. In patients primarily considered for surgical treatment, antiplatelet and anticoagulant drug therapy can be used as a means of promoting graft patency, and beta-adrenergic blockers can be used as a means of reducing the perioperative risks associated with vascular surgery.
外周动脉疾病（PAD）是全身性动脉粥样硬化的常见表现，与心血管疾病死亡风险高以及因肢体缺血导致的功能严重受限相关。患有PAD的患者应被视为患有严重的冠状动脉和脑动脉疾病，这需要积极管理危险因素，包括开具抗血小板药物处方，以降低随后发生心肌梗死、中风和死亡的风险。在PAD人群中，一级和二级证据支持使用他汀类药物进行血脂管理、使用血管紧张素转换酶-1抑制剂控制血压，以及使用阿司匹林或氯吡格雷作为抗血小板药物。一旦完成这些，就应评估肢体症状的严重程度，并开具结构化运动计划或选用如西洛他唑等药物来治疗间歇性跛行。对于主要考虑手术治疗的患者，抗血小板和抗凝药物治疗可作为促进移植物通畅的手段，β-肾上腺素能阻滞剂可作为降低与血管手术相关围手术期风险的手段。
