Espinola-Klein C
Abteilung für Angiologie, Zentrum für Kardiologie/Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55131, Mainz, Deutschland.
Herz. 2017 Dec;42(8):721-727. doi: 10.1007/s00059-017-4638-2.
The current European Society of Cardiology (ESC) guidelines on peripheral arterial diseases include recommendations on diagnostics and treatment of atherosclerotic manifestations in peripheral arteries. Because of the high coincidence of atherosclerosis in different arterial territories, screening for other atherosclerotic lesions is necessary in patients with clinical symptoms in one vascular bed. Consistent treatment of cardiovascular risk factors is important in all patients with peripheral atherosclerosis. This includes smoking cessation, statin therapy and control of blood pressure and blood glucose. All patients with carotid artery stenosis should be treated with antiplatelet drugs. In patients with symptomatic carotid artery stenosis and low periprocedural risk, early revascularization is recommended when the degree of stenosis is more than 50%. In asymptomatic carotid artery stenosis revascularization should only be considered if the risk for cerebral embolization is high and the periprocedural risk is low. Patients with peripheral arterial occlusive disease should only be treated with an antiplatelet drug if they are symptomatic. In cases of intermittent claudication supervised exercise training is strongly recommended. When activities of daily life are compromised despite training, revascularization by endovascular therapy first should be considered. In chronic limb-threatening ischemia early revascularization should be considered, preferably by venous bypass surgery. In patients with arterial hypertension and specific risk factors screening for renal artery stenosis is recommended. Particularly in patients with atherosclerotic renal artery stenosis, the indications for revascularization should be assessed very carefully.
欧洲心脏病学会（ESC）现行的外周动脉疾病指南包括关于外周动脉粥样硬化表现的诊断和治疗建议。由于不同动脉区域动脉粥样硬化的高重合性，对于在一个血管床出现临床症状的患者，有必要筛查其他动脉粥样硬化病变。对所有外周动脉粥样硬化患者而言，持续治疗心血管危险因素很重要。这包括戒烟、他汀类药物治疗以及控制血压和血糖。所有颈动脉狭窄患者均应接受抗血小板药物治疗。对于有症状的颈动脉狭窄且围手术期风险较低的患者，当狭窄程度超过50%时，建议尽早进行血运重建。对于无症状的颈动脉狭窄，仅当脑栓塞风险高且围手术期风险低时才应考虑血运重建。外周动脉闭塞性疾病患者仅在出现症状时才应接受抗血小板药物治疗。对于间歇性跛行患者，强烈建议进行有监督的运动训练。尽管进行了训练但日常生活活动仍受影响时，应首先考虑通过血管内治疗进行血运重建。对于慢性肢体威胁性缺血，应考虑尽早进行血运重建，最好通过静脉搭桥手术。对于有动脉高血压和特定危险因素的患者，建议筛查肾动脉狭窄。特别是对于动脉粥样硬化性肾动脉狭窄患者，应非常仔细地评估血运重建的指征。
