Medical University Department, Division of Angiology, Kantonsspital Aarau, Aargau, Switzerland.
Vasa. 2021 Feb;50(2):85-91. doi: 10.1024/0301-1526/a000897. Epub 2020 Jul 17.
An estimated 237 million people suffer from peripheral arterial disease (PAD), which is associated with high morbidity and mortality, and prevalence is still increasing. Currently, we do not have any randomized trials that compare screening to no screening specifically for PAD in the general population. Presently, PAD screening is not generally established. This systematic review gives an overview of relevant literature and guidelines. Screening usually focuses on ankle-brachial index (ABI)-measurement, which enables detection of asymptomatic and symptomatic PAD, but has limitations in diabetics. There are no sufficient data on PAD screening. Guideline recommendations are heterogeneous. While some advocate no screening until better data are available, most recommend selective screening despite insufficient data on morbidity and mortality reduction in consequence of screening. We support the only evidence-based screening strategy for PAD: combined screening for abdominal aortic aneurysm (AAA), PAD and arterial hypertension in men aged 65-74 according to the VIVA study. We additionally suggest a new simple three-step screening strategy for symptomatic PAD in all individuals aged 40 and older, who see a general practitioner: Asking one question ("Do you have pain or cramps in the legs during normal walking?") followed by physical examination (normal lower extremity pulse status?) in those, whose answer is "yes", and ABI measurement unless all pulses are normal.
据估计，有 2.37 亿人患有外周动脉疾病（PAD），该病与高发病率和死亡率相关，且其患病率仍在上升。目前，我们没有任何随机试验专门比较过针对一般人群的 PAD 筛查与不筛查。目前，尚未广泛开展 PAD 筛查。本系统评价综述了相关文献和指南。筛查通常侧重于踝肱指数（ABI）测量，它可以检测无症状和有症状的 PAD，但在糖尿病患者中存在局限性。关于 PAD 筛查，目前还没有足够的数据。指南建议存在异质性。虽然有些人主张在有更好的数据之前不进行筛查，但大多数人建议进行选择性筛查，尽管缺乏筛查可降低发病率和死亡率的数据。我们支持唯一基于证据的 PAD 筛查策略：根据 VIVA 研究，对 65-74 岁男性进行腹主动脉瘤（AAA）、PAD 和动脉高血压联合筛查。我们还建议在所有 40 岁及以上就诊于全科医生的有症状 PAD 个体中采用一种新的简单三步筛查策略：询问一个问题（“在正常行走时腿部是否有疼痛或痉挛？”），对回答为“是”的个体进行体格检查（下肢脉搏正常吗？），然后进行 ABI 测量，除非所有脉搏均正常。
