Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY, USA.
Maturitas. 2009 Dec 20;64(4):204-11. doi: 10.1016/j.maturitas.2009.10.001. Epub 2009 Oct 22.
Peripheral arterial disease (PAD) is chronic arterial occlusive disease of the lower extremities caused by atherosclerosis whose prevalence increases with age. Only one-half of women with PAD are symptomatic. Symptomatic and asymptomatic women with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease. Modifiable risk factors that predispose women to PAD include active cigarette smoking, passive smoking, diabetes mellitus, hypertension, dyslipidemia, increased plasma homocysteine levels and hypothyroidism. With regard to management, women who smoke should be encouraged to quit and referred to a smoking cessation program. Hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism require treatment. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in women with PAD and hypercholesterolemia. Anti-platelet drugs such as aspirin or especially clopidogrel, angiotensin-converting enzyme inhibitors and statins should be given to all women with PAD. Beta blockers are recommended if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided as it is ineffective. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery in women are (1) incapacitating claudication interfering with work or lifestyle; and (2) limb salvage in women with limb-threatening ischemia as manifested by rest pain, non-healing ulcers, and/or infection or gangrene. Future research includes investigation of mechanisms underlying why women have a higher risk of graft failure and major amputation.
外周动脉疾病（PAD）是下肢动脉粥样硬化性慢性闭塞性疾病，其患病率随年龄增长而增加。仅有一半的 PAD 女性有症状。有症状和无症状的 PAD 女性发生全因死亡率、心血管死亡率和冠心病死亡率增加的风险增加。易患 PAD 的可改变危险因素包括主动吸烟、被动吸烟、糖尿病、高血压、血脂异常、血浆同型半胱氨酸水平升高和甲状腺功能减退症。关于治疗，应鼓励吸烟的女性戒烟并转介至戒烟计划。高血压、糖尿病、血脂异常和甲状腺功能减退症需要治疗。他汀类药物可降低间歇性跛行的发生率，并改善 PAD 合并高胆固醇血症女性的运动持续时间直至间歇性跛行发作。所有 PAD 女性均应给予抗血小板药物如阿司匹林或氯吡格雷，血管紧张素转换酶抑制剂和他汀类药物。如果存在冠心病，则建议使用β受体阻滞剂。运动康复计划和西洛他唑可增加运动时间，直至发生间歇性跛行。应避免螯合疗法，因为它无效。女性下肢经皮腔内血管成形术或旁路手术的适应证为：（1）妨碍工作或生活方式的致残性跛行；（2）肢体有威胁性缺血的女性需要保肢治疗，表现为静息痛、不愈合溃疡和/或感染或坏疽。未来的研究包括研究为什么女性发生移植物失败和大截肢的风险更高的机制。
