Zheng Y H, Song X T
Department of Vascular Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China.
Zhonghua Wai Ke Za Zhi. 2021 Dec 1;59(12):961-964. doi: 10.3760/cma.j.cn112139-20210923-00453.
In the past five years,both advancements and new problems were seen in the treatment of lower extremity arteriosclerosis obliterans.The Global Vascular Guidelines published in 2019 have given us comprehensive suggestions for the diagnosis and treatment of critical limb threatening ischemia(CLTI),but the grading and treatment suggestions for CLTI should be generalized.As to endovascular treatment,drug coated balloons have been found to be effective for limb salvage and graft patency in femoropopliteal and infra-popliteal artery occlusive diseases.As to surgical revascularization,persistent education and surveillance are necessary to maintain the practical quality of this fundamental technique.Inframalleolar bypass could achieve good graft patency and limb salvage rate for in CLTI patients.Regional anesthesia has been found to have lower risk than general anesthesia for lower extremity surgical revascularization.Percutaneous deep vein arterialization might be helpful for limb salvage in patients with non-option CLTI.A brief review about the treatment of lower extremity arteriosclerosis obliterans is performed based on latest literatures and institutional experience.Understanding the present situation and development trend is important for peripheral vascular practitioners.
在过去五年中，下肢动脉硬化闭塞症的治疗既有进展，也出现了新问题。2019年发布的全球血管指南为威胁肢体的严重缺血（CLTI）的诊断和治疗提供了全面建议，但CLTI的分级和治疗建议应予以推广。在血管内治疗方面，已发现药物涂层球囊在股腘动脉和腘下动脉闭塞性疾病的肢体挽救和移植物通畅方面有效。在外科血管重建方面，持续的教育和监测对于维持这项基本技术的实际质量是必要的。踝下旁路移植术对于CLTI患者可实现良好的移植物通畅率和肢体挽救率。已发现区域麻醉在下肢外科血管重建中比全身麻醉风险更低。经皮深静脉动脉化可能有助于非选择性CLTI患者的肢体挽救。基于最新文献和机构经验，对下肢动脉硬化闭塞症的治疗进行简要综述。了解现状和发展趋势对外周血管从业者很重要。
