Kitslaar P J
Academisch Ziekenhuis, afd. Algemene Chirurgie, Maastricht.
Ned Tijdschr Geneeskd. 1997 Dec 6;141(49):2396-400.
Intermittent claudication is an indicator of increased risk of cardiac and cerebrovascular morbidity and mortality and as such a reason to look for modifiable risk factors for atherosclerosis. A vascular anamnesis and physical examination can reliably exclude presence of peripheral arterial occlusive disease in the lower extremities, but cannot reliably demonstrate its presence. Certainty about presence or absence of peripheral arterial occlusive disease can be obtained by determination of an ankle-brachial blood pressure index. The main method for the diagnosis of severity and localisation of stenoses and occlusions in the arteries to the legs is the echo-Doppler (duplex) examination. With this method the feasibility of percutaneous transluminal angioplasty (PTA) can also be determined. Consequently, angiography has lost importance as a diagnostic method and is only still indicated as part of an interventional treatment (operation or PTA). Treatment should be aimed at both amelioration of symptoms and reduction of risk factors for atherosclerosis. A key-stone of the treatment is cessation of smoking. The role of pharmacotherapy in reducing symptomatology is only limited. Walking exercise can have a positive effect on walking distance and should always be tried. PTA is the treatment modality of first choice for stenoses in the aortoiliac and femoropopliteal arteries. For segmental occlusions in the iliac pathway, also recanalisation by means of PTA (in combination with stent placement) is a justifiable treatment option. In all other cases operative revascularisations give good functional results. Invasive treatments for patients with intermittent claudication should be performed within a multidisciplinary team.
间歇性跛行是心血管和脑血管发病及死亡风险增加的一个指标，因此也是寻找动脉粥样硬化可改变风险因素的一个理由。血管病史采集和体格检查能够可靠地排除下肢外周动脉闭塞性疾病的存在，但无法可靠地证实其存在。通过测定踝肱血压指数可确定是否存在外周动脉闭塞性疾病。诊断腿部动脉狭窄和闭塞的严重程度及部位的主要方法是超声多普勒（双功）检查。利用这种方法还可以确定经皮腔内血管成形术（PTA）的可行性。因此，血管造影作为一种诊断方法已不再重要，仅在介入治疗（手术或PTA）中仍有必要进行。治疗应旨在缓解症状并降低动脉粥样硬化的风险因素。治疗的一个关键是戒烟。药物治疗在减轻症状方面的作用有限。步行锻炼对步行距离可能有积极影响，应始终尝试。PTA是主动脉髂动脉和股腘动脉狭窄的首选治疗方式。对于髂动脉段闭塞，通过PTA（结合支架置入）进行再通也是一种合理的治疗选择。在所有其他情况下，手术血管重建术可取得良好的功能效果。间歇性跛行患者的侵入性治疗应在多学科团队内进行。
