Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Curr Vasc Pharmacol. 2020;18(3):223-236. doi: 10.2174/1570161117666190206234606.
Lower extremity artery disease (LEAD) represents a major public health burden, affecting hundreds of millions of people worldwide. Although risk-factor modification, exercise training and medical treatment are the mainstays of the management of LEAD, endovascular or surgical revascularisation is recommended when there is the risk of limb amputation and when drug-resistant claudication severely affects patient lifestyle. Over recent years, the number of peripheral vascular interventions (PVI) has soared worldwide, driven by the improvements in endovascular techniques and devices. This growth was accompanied by a large number of clinical trials aimed at assessing the safety and efficacy of the various revascularisation modalities, while very little evidence was collected regarding the best antithrombotic treatment in patients undergoing peripheral revascularisation. In particular, considering the extensive length of diseased vessels usually treated in PVI, an optimised approach to both platelet function and coagulation cascade is of paramount importance. However, the role of antiplatelet and anticoagulant drugs following lower extremity revascularisation is largely extrapolated from the coronary field. Current guidelines recommend long-term single antiplatelet treatment for the majority of both endovascular and surgical revascularisation procedures, preceded by an initial short-term dual antiplatelet treatment in case of PVI. We present an overview of the indications and techniques of both endovascular and surgical peripheral revascularisation, followed by an in-depth analysis of the available evidence regarding type and duration of antiplatelet and anticoagulant treatment following revascularisation.
下肢动脉疾病 (LEAD) 是一个重大的公共健康负担，影响着全球数亿人。虽然危险因素的改变、运动训练和药物治疗是 LEAD 管理的主要方法，但当存在截肢风险且药物难治性跛行严重影响患者生活方式时，建议进行血管内或手术血运重建。近年来，由于血管内技术和设备的改进，全球外周血管介入 (PVI) 的数量猛增。这种增长伴随着大量旨在评估各种血运重建方式的安全性和有效性的临床试验，而在外周血运重建患者中进行最佳抗血栓治疗的证据却很少。特别是，考虑到 PVI 中通常治疗的病变血管的广泛长度，优化血小板功能和凝血级联的方法至关重要。然而，下肢血运重建后抗血小板和抗凝药物的作用在很大程度上是从冠状动脉领域推断出来的。目前的指南建议对大多数血管内和手术血运重建术进行长期单一抗血小板治疗，在 PVI 情况下，先进行短期双联抗血小板治疗。我们介绍了血管内和手术外周血运重建的适应证和技术，然后深入分析了血运重建后抗血小板和抗凝治疗的类型和持续时间的现有证据。
