Espinola-Klein Christine
Abteilung Angiologie, Zentrum für Kardiologie/Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland.
Herz. 2020 Apr;45(2):201-208. doi: 10.1007/s00059-020-04896-1.
Lower extremity arterial disease (LEAD) is a frequent manifestation of atherosclerosis with a high risk for cardiovascular events. The measurement of the ankle-brachial index (ABI) should be used as a screening method for LEAD. A differentiation is made between a stable stage of intermittent claudication and the stage of critical limb ischemia. The control of cardiovascular risk factors is crucial. Particular emphasis should be placed on smoking cessation and lipid-lowering treatment with statins and a target low-density lipoprotein (LDL)-cholesterol level of <55 mg/dl as a core element. In patients with symptomatic LEAD an inhibition of platelet aggregation is indicated. In addition to treatment with clopidogrel 75 mg or with acetylsalicylic acid (ASS) 100 mg in high risk patients the combination of ASS 100 mg and rivaroxaban 2 × 2.5 mg can be indicated. In critical limb ischemia revascularization (percutaneous intervention, operation) is always indicated to prevent amputation. First-line treatment in patients with intermittent claudication is exercise training. Revascularization can be indicated in patients with a severe limitation of walking distance.
下肢动脉疾病（LEAD）是动脉粥样硬化的常见表现，具有较高的心血管事件风险。踝臂指数（ABI）测量应用作LEAD的筛查方法。间歇性跛行的稳定期与严重肢体缺血期有所不同。控制心血管危险因素至关重要。应特别强调戒烟以及使用他汀类药物进行降脂治疗，并将低密度脂蛋白（LDL）胆固醇目标水平设定为<55mg/dl作为核心要素。对于有症状的LEAD患者，需进行血小板聚集抑制治疗。除了在高危患者中使用75mg氯吡格雷或100mg乙酰水杨酸（ASS）治疗外，还可考虑使用100mg ASS与2×2.5mg利伐沙班联合治疗。对于严重肢体缺血，始终需要进行血运重建（经皮介入、手术）以防止截肢。间歇性跛行患者的一线治疗是运动训练。对于步行距离严重受限的患者，可考虑进行血运重建。
