Middle German Heart Center-Bitterfeld, Bitterfeld-Wolfen Health Care Center, Bitterfeld, Germany; Diabetic Foot Unit, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
Dtsch Arztebl Int. 2023 May 30;120(21):365-372. doi: 10.3238/arztebl.m2023.0066.
Medial sclerosis (MeS) is a chronic systemic vascular disease that mainly affects the arteries of the lower limb. Its prevalence in the general population is approximately 2.5% (range: 1.6% to 10.0%). It is more common in men than in women.
This review is based on pertinent publications retrieved by a selective search in PubMed.
MeS is the final common pathway of a wide variety of diseases; its pathogenesis is not fully understood. It often remains clinically silent for decades and is usually diagnosed as an incidental finding or in a late stage. MeS with or without atherosclerosis is the most common histologic finding after limb amputation. MeS of the below-the-knee arteries is a major risk factor for chronic critical leg ischemia (OR:13.25, 95% confidence interval: [1.69; 104.16]) and amputation (RR 2.27, [1.89; 2.74]). Patients with peripheral arterial occlusive disease and marked calcification have a much higher risk of amputation (OR 2.88, [1.18; 12.72]) and a higher mortality (OR 5.16, [1.13; 21.61]). MeS is a risk factor for the failure of endovascular treatment of the pedal arteries (OR 4.0, [1.1; 16.6]). The more marked the calcification, the higher the risk of major amputation (HR 10.6 [1.4; 80.7] to HR 15.5 [2.0; 119]). Patients with vascular calcifications have been found to have lower patency rates and higher treatment failure rates two years after open surgical revascularization of the below-the-knee arteries. No pharmacotherapy for MeS is available to date.
MeS is an important risk factor for chronic critical lower limb ischemia, amputation, morbidity, and complications, particularly after endovascular and surgical procedures.
多发性硬化症（MeS）是一种慢性系统性血管疾病，主要影响下肢动脉。其在普通人群中的患病率约为 2.5%（范围：1.6%至 10.0%）。男性比女性更为常见。
本综述基于在 PubMed 中进行的选择性搜索中检索到的相关出版物。
MeS 是多种疾病的最终共同途径；其发病机制尚未完全阐明。它通常在数十年内保持临床无症状，并且通常被诊断为偶然发现或晚期发现。有或没有动脉粥样硬化的 MeS 是截肢后最常见的组织学发现。膝下动脉的 MeS 是慢性严重肢体缺血（OR：13.25，95%置信区间：[1.69；104.16]）和截肢（RR 2.27，[1.89；2.74]）的主要危险因素。患有外周动脉阻塞性疾病和明显钙化的患者截肢（OR 2.88，[1.18；12.72]）和死亡率（OR 5.16，[1.13；21.61]）的风险更高。MeS 是足动脉腔内治疗失败的危险因素（OR 4.0，[1.1；16.6]）。钙化越严重，主要截肢的风险越高（HR 10.6 [1.4；80.7]至 HR 15.5 [2.0；119]）。在膝下动脉开放性血管重建术后两年，发现有血管钙化的患者通畅率较低，治疗失败率较高。目前尚无治疗 MeS 的药物疗法。
MeS 是慢性严重下肢缺血、截肢、发病率和并发症的重要危险因素，尤其是在血管内和手术治疗后。
