Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.
Département d'Endocrinologie, Diabétologie, Nutrition, Assistance Publique - Hôpitaux de Paris, Hospital Bichat, DHU FIRE, Paris, France.
Cardiovasc Diabetol. 2018 Oct 23;17(1):138. doi: 10.1186/s12933-018-0781-1.
Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthfull to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patients and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes.
下肢动脉疾病（LEAD）是一种主要的地方性疾病，在全球范围内患病率呈惊人的上升趋势。它是一种常见且严重的疾病，存在发生主要心血管事件和死亡的风险过高。它还会导致下肢不良事件和非创伤性截肢的发生率较高。美国糖尿病协会建议进行广泛的病史和临床检查，以筛查 LEAD。踝肱指数（ABI）是推荐用于诊断 LEAD 的第一个非侵入性工具，尽管其在糖尿病患者中的表现存在差异。ABI 的表现特别受周围神经病变、动脉中层钙化和不可压缩动脉的影响。目前，在这些情况下，没有强有力的证据支持替代 LEAD 诊断的测试。LEAD 的管理需要严格控制心血管危险因素，包括糖尿病、高血压和血脂异常。强化与标准血糖控制对 LEAD 风险的益处尚未明确确定。抗高血压、降脂和抗血小板药物显然有助于降低主要心血管不良事件的风险，但很少有随机对照试验（RCT）评估这些治疗方法在 LEAD 及其相关不良事件方面的益处。戒烟、体育活动、监督步行康复和健康饮食对于 LEAD 的管理也至关重要。血管内和手术血运重建手术方面取得了一些进展，LEAD 的管理明显改善。血运重建策略应考虑到几个因素，包括病变的解剖定位、每位患者的病史和操作者的经验。需要进一步的研究，特别是 RCT，以评估不同治疗策略在糖尿病患者中 LEAD 的发生、进展及其相关不良事件方面的益处。
