Halperin J L
Division of Cardiology, Mount Sinai Medical Center, New York.
Geriatrics. 1987 Nov;42(11):47-8, 53, 57-61.
Peripheral arterial obstructive disease with symptoms of ischemia in the limbs is a common cause of disability, morbidity, and even mortality in the elderly. The most important cause is atherosclerosis, which is ultimately a systemic problem, but the cardinal symptom in the limbs is intermittent claudication. Unfortunately, the elderly patient often displays severe ischemia with pain at rest, and ulceration or gangrene of the extremity, even where there was a paucity of prior claudication, perhaps due to associated illness which reduces mobility. The essential aspects of clinical diagnosis and assessment of severity of ischemia involve relatively simple bedside techniques, and noninvasive laboratory methodology is mainly of value in selection of patients for angiography and potential revascularization. While conventional therapy involves bypass surgery, an expanding array of drugs and the advent of interventional angiographic measures including angioplasty offer alternatives which were not available even a few years ago.
伴有肢体缺血症状的外周动脉阻塞性疾病是老年人残疾、发病甚至死亡的常见原因。最重要的病因是动脉粥样硬化，这归根结底是一个全身性问题，但肢体的主要症状是间歇性跛行。不幸的是，老年患者常表现为严重缺血，伴有静息痛、肢体溃疡或坏疽，即使之前很少有跛行症状，这可能是由于相关疾病导致活动能力下降所致。临床诊断和评估缺血严重程度的基本方面涉及相对简单的床边检查技术，非侵入性实验室方法主要在选择进行血管造影和可能的血运重建的患者方面具有价值。虽然传统治疗包括搭桥手术，但越来越多的药物以及包括血管成形术在内的介入血管造影措施的出现提供了甚至几年前都没有的替代方案。
