Svetlikov A V, Ishpulaeva L É
Department of Vascular Surgery, North-Western District Scientific Clinical Centre named after L.G. Sokolov under the Federal Biomedical Agency of the Russian Federation, Saint Petersburg, Russia; Department of Cardiovascular Surgery, North-Western State Medical University named after I.I. Mechnikov under the RF Ministry of Public Health, Saint Petersburg, Russia.
Department of Vascular Surgery, North-Western District Scientific Clinical Centre named after L.G. Sokolov under the Federal Biomedical Agency of the Russian Federation, Saint Petersburg, Russia.
Angiol Sosud Khir. 2020;26(4):23-31. doi: 10.33529/ANGIO2020423.
Treatment of patients presenting with peripheral artery disease requires a comprehensive approach: correction of risk factors, drug therapy and, if necessary, an endovascular/hybrid/open intervention. Reconstructive operation may effectively improve a patient's quality of life in intermittent claudication, save the limb and life in case of severe ischaemia. Discussed in the article are advantages and disadvantages of various types of surgical interventions for peripheral artery disease, the concept PLAN (Patient risk, Limb severity, and ANatomic complexity) and the new Global Anatomic Staging System (GLASS). Good remote results may be ensured by adequate medicamentous therapy. Variations of antithrombotic therapy are versatile and debatable. Long-term dual antithrombotic or systemic anticoagulant therapy with administration of vitamin K antagonists are not indicated for peripheral artery disease. In this connection, the findings of the COMPASS and VOYAGER PAD studies are analysed. The VOYAGER PAD trial showed that in patients with peripheral artery disease who underwent revascularization of lower limbs, the addition of rivaroxaban at a dose of 2.5 mg twice daily to aspirin decreased the risk of lower-extremity unfavourable ischaemic events and major adverse cardiovascular events by 15%. The obtained findings open new possibilities of conservative therapy having a significant role in decreasing the risk for development of limb-threatening conditions.
纠正危险因素、药物治疗，必要时进行血管内/杂交/开放手术干预。重建手术可有效改善间歇性跛行患者的生活质量，在严重缺血的情况下挽救肢体和生命。本文讨论了外周动脉疾病各种手术干预的优缺点、PLAN（患者风险、肢体严重程度和解剖复杂性）概念以及新的全球解剖分期系统（GLASS）。适当的药物治疗可确保良好的远期效果。抗血栓治疗的变化多样且存在争议。长期双重抗血栓或使用维生素K拮抗剂的全身抗凝治疗不适用于外周动脉疾病。就此，分析了COMPASS和VOYAGER PAD研究的结果。VOYAGER PAD试验表明，在接受下肢血运重建的外周动脉疾病患者中，在阿司匹林基础上加用每日两次2.5毫克利伐沙班可使下肢不良缺血事件和主要不良心血管事件的风险降低15%。这些研究结果为保守治疗开辟了新的可能性，在降低肢体威胁性疾病发生风险方面具有重要作用。
