Hiatt W R
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA.
Vasc Med. 1997;2(3):257-62. doi: 10.1177/1358863X9700200316.
The primary objectives of claudication treatment are to reduce cardiovascular mortality and improve walking ability. Patients with claudication have 60% mortality over 10 years, with most deaths due to myocardial infarction and stroke. Aggressive risk-factor modification is required in all these patients, particularly smoking cessation, lipid modification, and treatment of hypertension, diabetes and elevated homocysteine levels. Aspirin, ticlopidine and clopidogrel are all effective in reducing the risk of myocardial infarction, stroke and vascular death, and thus antiplatelet therapy should be considered in all claudicants. Patients with disabling claudication should be considered for therapies that relieve claudication pain and improve exercise performance, the most effective being exercise training and smoking cessation. Pentoxifylline, the only approved claudication drug in the United States, has modest efficacy in improving treadmill exercise performance. Other drugs shown to be of some benefit in patients with claudication include propionyl-L-carnitine, cilostazol and possibly prostaglandin derivatives. Several antiplatelet agents and angiogenic growth factors are also being evaluated for the treatment of claudication.
间歇性跛行治疗的主要目标是降低心血管死亡率并提高行走能力。间歇性跛行患者10年内的死亡率为60%，大多数死亡原因是心肌梗死和中风。所有这些患者都需要积极改变危险因素，特别是戒烟、调整血脂以及治疗高血压、糖尿病和高同型半胱氨酸水平。阿司匹林、噻氯匹定和氯吡格雷在降低心肌梗死、中风和血管死亡风险方面均有效，因此所有间歇性跛行患者都应考虑抗血小板治疗。对于致残性间歇性跛行患者，应考虑采用缓解跛行疼痛并改善运动能力的治疗方法，其中最有效的是运动训练和戒烟。己酮可可碱是美国唯一获批用于治疗间歇性跛行的药物，在改善跑步机运动能力方面疗效一般。其他已证明对间歇性跛行患者有一定益处的药物包括丙酰-L-肉碱、西洛他唑以及可能的前列腺素衍生物。几种抗血小板药物和血管生成生长因子也正在接受评估用于治疗间歇性跛行。
