Krankenberg H
Zentrum für Gefäßmedizin, Abteilung Angiologie, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland.
Internist (Berl). 2019 Dec;60(12):1235-1239. doi: 10.1007/s00108-019-00695-x.
Peripheral artery disease (PAD) is often diagnosed in an advanced stage. Accordingly, revascularization is also performed late.
In this paper, the authors describe the progression to critical limb ischemia and cardiovascular risk. Revascularization for secondary prevention is explained. Revascularization strategies according to lesion location and complexity of the stenosis or occlusion are discussed.
The current guidelines and randomized controlled studies and meta-analyses are analyzed.
PAD is associated with a considerable level of suffering and a high cardiovascular risk. Up to 20% of patients with claudicants will progress to critical limb ischemia. Progression and risk of mortality increase during the course of the disease. Improvement of walking ability by revascularization is a major goal of secondary prevention. In the femoropopliteal segment, drug-coated balloon (DCB) angioplasty and bare-metal stent (BMS) implantation are the methods of choice. In long lesions, spot-stenting should be preferred. For treatment of in-stent restenosis, DCB have proven their effectiveness. In severely calcified or dissected lesions, BMS are well suited. Infrapopliteal lesions should be revascularized to provide in-line flow to the foot through the target arterial path. According to current evidence, DCB or drug-eluting stents are more effective than plain old balloon angioplasty or BMS.
外周动脉疾病（PAD）常于晚期被诊断出来。因此，血管重建术也在晚期进行。
在本文中，作者描述了肢体严重缺血的进展情况以及心血管风险。解释了二级预防中的血管重建术。讨论了根据病变位置以及狭窄或闭塞的复杂程度制定的血管重建策略。
分析当前的指南、随机对照研究以及荟萃分析。
PAD与相当程度的痛苦和高心血管风险相关。高达20%的间歇性跛行患者会进展为肢体严重缺血。疾病过程中，病情进展和死亡风险会增加。通过血管重建术改善步行能力是二级预防的主要目标。在股腘动脉段，药物涂层球囊（DCB）血管成形术和裸金属支架（BMS）植入是首选方法。对于长病变，应优先选择点状支架置入术。对于支架内再狭窄的治疗，DCB已证明其有效性。在严重钙化或夹层病变中，BMS很适用。腘以下病变应进行血管重建，以通过目标动脉路径为足部提供直线血流。根据目前的证据，DCB或药物洗脱支架比普通老式球囊血管成形术或BMS更有效。
