Garcia Lawrence A
Division of Cardiology and Vascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
J Endovasc Ther. 2006 Feb;13 Suppl 2:II3-9. doi: 10.1177/15266028060130S204.
Peripheral arterial disease (PAD), a major cause of disability, loss of work, and lifestyle changes in the United States, is defined as obstruction of blood flow into an arterial tree excluding the intracranial or coronary circulations. PAD is mostly silent in its early stages, but when lesion obstruction exceeds 50%, it may cause intermittent claudication with ambulation. Further disease progression typically leads to rest pain or frank tissue loss. However, some patients may remain asymptomatic with severe disease because of extensive collateralization in the lower extremity. Estimates of the prevalence of intermittent claudication vary by population, from 0.6% to nearly 10%; the rate increases dramatically with age. Approximately 20% to 25% of patients will require revascularization, while fewer than 5% will progress to critical limb ischemia. Limb loss, although rare, is associated with severe disability and an overall poor prognosis, with 30% to 40% mortality in the first 24 months after limb loss. As with coronary artery disease, the most common cause of symptomatic obstruction in the peripheral arterial tree is atherosclerosis, a systemic inflammatory process in which cholesterol-laden plaque builds up in the artery and eventually blocks the lumen. Typical risk factors include age, gender, diabetes, tobacco abuse, hypertension, and hyperlipidemia.
外周动脉疾病（PAD）是美国导致残疾、工作丧失和生活方式改变的主要原因，其定义为流入动脉树的血流受阻，但不包括颅内或冠状动脉循环。PAD在早期大多没有症状，但当病变阻塞超过50%时，可能会在行走时引起间歇性跛行。疾病进一步发展通常会导致静息痛或明显的组织缺失。然而，由于下肢广泛的侧支循环，一些患有严重疾病的患者可能仍无症状。间歇性跛行患病率的估计因人群而异，从0.6%到近10%不等；患病率随年龄急剧增加。约20%至25%的患者需要进行血运重建，而进展为严重肢体缺血的患者不到5%。肢体缺失虽然罕见，但与严重残疾和总体预后不良相关，肢体缺失后的头24个月内死亡率为30%至40%。与冠状动脉疾病一样，外周动脉树中有症状性阻塞的最常见原因是动脉粥样硬化，这是一种全身性炎症过程，其中富含胆固醇的斑块在动脉中积聚并最终阻塞管腔。典型的危险因素包括年龄、性别、糖尿病、吸烟、高血压和高脂血症。
