Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
Nat Rev Cardiol. 2022 Jul;19(7):456-474. doi: 10.1038/s41569-021-00663-9. Epub 2022 Jan 7.
Approximately 6% of adults worldwide have atherosclerosis and thrombosis of the lower limb arteries (peripheral artery disease (PAD)) and the prevalence is rising. PAD causes leg pain, impaired health-related quality of life, immobility, tissue loss and a high risk of major adverse events, including myocardial infarction, stroke, revascularization, amputation and death. In this Review, I describe the pathophysiology, presentation, outcome, preclinical research and medical management of PAD. Established treatments for PAD include antithrombotic drugs, such as aspirin and clopidogrel, and medications to treat dyslipidaemia, hypertension and diabetes mellitus. Randomized controlled trials have demonstrated that these treatments reduce the risk of major adverse events. The drug cilostazol, exercise therapy and revascularization are the current treatment options for the limb symptoms of PAD, but each has limitations. Novel therapies to promote collateral and new capillary growth and treat PAD-related myopathy are under investigation. Methods to improve the implementation of evidence-based medical management, novel drug therapies and rehabilitation programmes for PAD-related pain, functional impairment and ischaemic foot disease are important areas for future research.
全世界约有 6%的成年人患有下肢动脉粥样硬化和血栓形成（外周动脉疾病 (PAD)），且其发病率正在上升。PAD 会导致腿部疼痛、健康相关生活质量下降、行动不便、组织丧失以及发生重大不良事件（包括心肌梗死、中风、血运重建、截肢和死亡）的风险较高。在这篇综述中，我描述了 PAD 的病理生理学、临床表现、结局、临床前研究和医学管理。PAD 的既定治疗方法包括抗血栓药物，如阿司匹林和氯吡格雷，以及治疗血脂异常、高血压和糖尿病的药物。随机对照试验表明，这些治疗方法可降低重大不良事件的风险。西洛他唑、运动疗法和血运重建是 PAD 肢体症状的当前治疗选择，但每种方法都有其局限性。正在研究促进侧支和新毛细血管生长以及治疗 PAD 相关肌肉疾病的新型治疗方法。改善基于证据的医学管理、新型药物治疗以及治疗 PAD 相关疼痛、功能障碍和缺血性足部疾病的康复方案的方法是未来研究的重要领域。
