Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston.
Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston.
Am J Med. 2019 Oct;132(10):1133-1141. doi: 10.1016/j.amjmed.2019.04.043. Epub 2019 May 29.
Peripheral artery disease is a prevalent but underdiagnosed manifestation of atherosclerosis. There is insufficient awareness of its clinical manifestations, including intermittent claudication and critical limb ischemia and of its risk of adverse cardiovascular and limb outcomes. In addition, our inadequate knowledge of its pathophysiology has also limited the development of effective treatments, particularly in the presence of critical limb ischemia. This review aims to highlight essential elements of the epidemiology and pathophysiology of peripheral artery disease, bring attention to the often-atypical manifestations of occlusive arterial disease of the lower extremity, increase awareness of critical limb ischemia, briefly describe the diagnostic role of the ankle brachial index, and go over the contemporary management of peripheral artery disease. An emphasis is placed on evidence-based medical treatments to improve symptoms and quality of life and to reduce the risk of cardiovascular and limb events in these patients, including supervised exercise training, smoking cessation, antagonism of the renin-angiotensin system, lipid-lowering, antiplatelet, and antithrombotic therapies.
外周动脉疾病是动脉粥样硬化的一种常见但未被充分诊断的表现。人们对外周动脉疾病的临床表现（包括间歇性跛行和严重肢体缺血）及其对心血管和肢体不良结局的风险认识不足。此外，我们对外周动脉疾病病理生理学的了解不足，也限制了有效治疗方法的发展，尤其是在严重肢体缺血的情况下。这篇综述旨在强调外周动脉疾病的流行病学和病理生理学的基本要素，引起对下肢动脉闭塞性疾病的非典型表现的关注，提高对严重肢体缺血的认识，简要描述踝肱指数的诊断作用，并回顾外周动脉疾病的当代治疗方法。重点介绍了基于循证的医疗治疗方法，以改善症状和生活质量，并降低这些患者发生心血管和肢体事件的风险，包括监督下的运动训练、戒烟、肾素-血管紧张素系统拮抗、降脂、抗血小板和抗血栓治疗。
