Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA.
Departments of Surgery and Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Nat Rev Cardiol. 2018 Jun;15(6):332-350. doi: 10.1038/s41569-018-0005-0.
Peripheral artery disease (PAD) of the lower extremities is a common manifestation of atherosclerosis that is increasing in global prevalence and in the associated public health costs. Ageing of the general population, combined with the pandemics of diabetes mellitus, metabolic syndrome, and tobacco use, is a major underlying factor. A broad range of care providers are involved in the management of patients with PAD, and all health-care professionals require familiarity with the risk factors, diagnosis, and treatment options for this common disease. Although medical therapies are the cornerstone of secondary prevention in atherosclerotic disease, they have limited direct limb-related benefits in advanced PAD. Despite a major evolution in technologies for limb revascularization, the increasing array of treatment options has not been accompanied by adequate evidence of their comparative effectiveness, which is needed to guide treatment decisions. This Review provides a framework for examining the current status of interventions for PAD, including an overview of disease staging, treatment goals, and the key factors associated with outcomes in defined subgroups. The status of evolving approaches to PAD, such as cell-based and gene-based therapies, and persistent unmet therapeutic needs in this field are also discussed.
下肢外周动脉疾病 (PAD) 是动脉粥样硬化的一种常见表现，其在全球的患病率和相关公共卫生费用都在不断增加。人口老龄化，加上糖尿病、代谢综合征和烟草使用的流行，是一个主要的潜在因素。广泛的医疗保健提供者都参与了 PAD 患者的管理，所有医疗保健专业人员都需要熟悉这种常见疾病的危险因素、诊断和治疗选择。尽管医学治疗是动脉粥样硬化性疾病二级预防的基石，但在晚期 PAD 中，它们对肢体的直接相关益处有限。尽管肢体血运重建技术有了重大发展，但治疗选择的范围不断扩大，并没有伴随足够的比较有效性证据，而这是指导治疗决策所必需的。本综述提供了一个检查 PAD 干预措施现状的框架，包括疾病分期、治疗目标以及与特定亚组结局相关的关键因素的概述。还讨论了 PAD 领域中新兴方法的现状，如基于细胞和基因的治疗，以及该领域中持续存在的未满足的治疗需求。
