Ouriel K
Department of Surgery, University of Rochester, NY 14642, USA.
Vasc Med. 1996;1(2):159-61. doi: 10.1177/1358863X9600100213.
Patients with peripheral arterial occlusion may be treated with one of three distinct treatment strategies: observation and/or anticoagulation alone, operative intervention, or catheter-directed thrombolytic therapy. The severity of symptoms is the most important clinical parameter with which to formulate clinical strategies. Patients with non-lifestyle limiting claudication may be best managed without arteriographic investigation, managing symptoms conservatively with exercise, cessation of smoking, and occasionally the oral pharmacologic agent pentoxifylline. Patients with threatened limbs in the form of rest pain or tissue loss carry a high risk of limb loss without intervention. These patients should undergo arteriography with consideration of endovascular intervention for focal lesions and bypass grafting for more diffuse disease. Patients with more acute symptoms may be best treated with catheter-directed thrombolytic therapy, addressing unmasked lesions responsible for the occlusion with an operative or endovascular approach. In all cases, the appropriate therapy must be tailored to the clinical presentation, the anatomic distribution of disease, and the experience of the clinical team.
单纯观察和/或抗凝、手术干预或导管定向溶栓治疗。症状的严重程度是制定临床策略最重要的临床参数。对于无生活方式限制的间歇性跛行患者，可不进行血管造影检查，通过运动、戒烟以及偶尔使用口服药物己酮可可碱保守治疗症状，这样可能是最佳的处理方式。以静息痛或组织缺失形式出现的肢体受到威胁的患者，如果不进行干预，肢体丧失的风险很高。这些患者应接受血管造影检查，考虑对局限性病变进行血管内介入治疗，对更弥漫性疾病进行旁路移植术。症状较急性的患者可能最好采用导管定向溶栓治疗，通过手术或血管内方法处理导致闭塞的隐匿病变。在所有情况下，适当的治疗必须根据临床表现、疾病的解剖分布以及临床团队的经验进行调整。
