Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
Vasc Med. 2021 Apr;26(2):210-224. doi: 10.1177/1358863X20987612. Epub 2021 Feb 15.
Critical limb ischemia (CLI) constitutes the most advanced form of peripheral artery disease (PAD) and is characterized by ischemic rest pain, tissue loss and/or gangrene. Optimized medical care and risk factor modification in addition to revascularization could reduce the incidence of cardiovascular events and major adverse limb events, improving patients' quality of life and promising higher survival rates. Adequate adherence to cardioprotective medications, including antithrombotic therapy (e.g., antiplatelets, anticoagulants), cholesterol-lowering agents (e.g., statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors), angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and smoking cessation should be strongly encouraged for patients with CLI. This review examines these guideline-recommended therapies in terms of cardiovascular and limb-related risk reduction in patients with CLI.
严重肢体缺血（CLI）是外周动脉疾病（PAD）的最严重形式，其特征为缺血性静息痛、组织损失和/或坏疽。除了血运重建之外，优化的医疗护理和危险因素修正，加上血运重建，可降低心血管事件和主要不良肢体事件的发生率，提高患者的生活质量，并有望提高生存率。强烈鼓励 CLI 患者充分坚持使用心脏保护药物，包括抗血栓治疗（例如，抗血小板、抗凝剂）、降胆固醇药物（例如，他汀类药物、前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂）、血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB），以及戒烟。本文从心血管和肢体相关风险降低的角度，对 CLI 患者的这些指南推荐治疗进行了考察。
