Lawall Holger, Huppert Peter, Espinola-Klein Christine, Zemmrich Claudia Silke, Ruemenapf Gerhard
1 Akademie für Gefäßkrankheiten Ettlingen, Max Grundig Klinik, Bühlerhöhe, Germany.
2 Institut für Radiologie, Klinikum Darmstadt, Germany.
Vasa. 2017 Mar;46(2):79-86. doi: 10.1024/0301-1526/a000603. Epub 2017 Jan 27.
The prevalence of peripheral artery disease (PAD) is increasing worldwide and is strongly age-related, affecting about 20 % of Germans over 70 years of age. Recent advances in endovascular and surgical techniques as well as clinical study results on comparative treatment methods strengthened the need for a comprehensive review of the published evidence for diagnosis, management, and prevention of PAD. The interdisciplinary guideline exclusively covers distal aorta and atherosclerotic lower extremity artery disease. A systematic literature review and formal consensus finding process, including delegated members of 22 medical societies and two patient self-support organisations were conducted and supervised by the Association of Scientific Medical Societies in Germany, AWMF. Three levels of recommendation were defined, A = "is recommended/indicated", B = "should be considered", C = "may be considered", means agreement of expert opinions due to lack of evidence. Altogether 294 articles, including 34 systematic reviews and 98 RCTs have been analysed. The key diagnostic tools and treatment basics have been defined. In patients with intermittent claudication endovascular and/or surgical techniques are treatment options depending on appropriate individual morphology and patient preference. In critical limb ischaemia, revascularisation without delay by means of the most appropriate technique is key. If possible and reasonable, endovascular procedures should be applied first. The TASC classification is no longer recommended as the base of therapeutic decision process due to advances in endovascular techniques and new crural therapeutic options. Limited new data on rehabilitation and follow-up therapies have been integrated. The article summarises major new aspects of PAD treatment from the updated German Guidelines for Diagnosis and Treatment of PAD. Limited scientific evidence still calls for randomised clinical trials to close the present gap of evidence.
外周动脉疾病（PAD）在全球的患病率正在上升，且与年龄密切相关，70岁以上的德国人中约20%受其影响。血管内和外科技术的最新进展以及关于比较治疗方法的临床研究结果，强化了对已发表的PAD诊断、管理和预防证据进行全面综述的必要性。该跨学科指南专门涵盖了腹主动脉远端和下肢动脉粥样硬化疾病。德国科学医学协会联合会（AWMF）开展并监督了一项系统的文献综述和正式的共识达成过程，其中包括22个医学协会和两个患者自助组织的代表成员。定义了三个推荐级别，A = “推荐/适用”，B = “应考虑”，C = “可考虑”，表示由于缺乏证据而达成的专家意见一致。总共分析了294篇文章，包括34篇系统综述和98项随机对照试验。确定了关键的诊断工具和治疗基础。对于间歇性跛行患者，根据合适的个体形态和患者偏好，血管内和/或外科技术是治疗选择。在严重肢体缺血中，采用最合适的技术立即进行血运重建是关键。如果可能且合理，应首先应用血管内手术。由于血管内技术的进步和新的小腿治疗选择，不再推荐将TASC分类作为治疗决策过程的基础。关于康复和后续治疗的新数据有限，已纳入其中。本文总结了德国PAD诊断和治疗更新指南中PAD治疗的主要新方面。有限的科学证据仍需要随机临床试验来填补目前的证据空白。
