Geisel School of Medicine at Dartmouth, Hanover, NH.
Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA.
Semin Vasc Surg. 2022 Jun;35(2):141-154. doi: 10.1053/j.semvascsurg.2022.05.003. Epub 2022 May 8.
Peripheral artery disease (PAD), the pathophysiologic narrowing of arterial blood vessels of the lower leg due to atherosclerosis, is a highly prevalent disease that affects more than 6 million individuals 40 years and older in the United States, with sharp increases in prevalence with age. Morbidity and mortality rates in patients with PAD range from 30% to 70% during the 5- to 15-year period after diagnosis and PAD is associated with poor health outcomes and reduced functionality and quality of life. Despite advances in medical, endovascular, and open surgical techniques, there is striking variation in care among population subgroups defined by sex, race and ethnicity, and socioeconomic status, with concomitant differences in preoperative medication optimization, amputation risk, and overall health outcomes. We reviewed studies from 1995 to 2021 to provide a comprehensive analysis of the current impact of disparities on the treatment and management of PAD and offer action items that require strategic partnership with primary care providers, researchers, patients, and their communities. With new technologies and collaborative approaches, optimal management across all population subgroups is possible.
外周动脉疾病(PAD)是一种由于动脉粥样硬化导致小腿动脉病理性变窄的疾病,在美国,40 岁及以上人群中有超过 600 万人患有这种高度流行的疾病,且随着年龄的增长,患病率急剧上升。在诊断后 5 至 15 年内,PAD 患者的发病率和死亡率在 30%至 70%之间,PAD 与不良健康结果以及功能和生活质量下降有关。尽管在医学、血管内和开放性手术技术方面取得了进展,但根据性别、种族和民族以及社会经济地位定义的人群亚组之间的护理存在显著差异,同时在术前药物优化、截肢风险和整体健康结果方面也存在差异。我们回顾了 1995 年至 2021 年的研究,全面分析了目前差异对 PAD 治疗和管理的影响,并提供了需要与初级保健提供者、研究人员、患者及其社区建立战略伙伴关系的行动项目。通过新技术和合作方法,所有人群亚组都可以实现最佳管理。