Medical Therapy in Peripheral Artery Disease and Critical Limb Ischemia

被引:11
作者
Foley T.R. [1 ]
Waldo S.W. [1 ]
Armstrong E.J. [1 ]
机构
[1] VA Eastern Colorado Healthcare System and Division of Cardiology, University of Colorado School of Medicine, Denver, CO
关键词
Critical limb ischemia; Peripheral artery disease; Therapy; Vascular disease;
D O I
10.1007/s11936-016-0464-8
中图分类号
学科分类号
摘要
Peripheral artery disease (PAD) comprises atherosclerosis of the aorta and lower extremities. Many patients with PAD are asymptomatic, while others present with intermittent claudication (IC) or critical limb ischemia (CLI). Defined as rest pain or tissue loss that persists for >2 weeks, CLI represents the most severe clinical manifestation of PAD and is associated with an increased risk of limb loss and death. Patients with PAD, including those with CLI, are underdiagnosed and undertreated. In addition to smoking cessation, medical therapy with an antiplatelet agent and statin is recommended for all patients with PAD. Regular exercise has been shown to improve walking distance and quality of life in patients with symptomatic PAD and should be incorporated into each patient’s treatment plan. In patients who have CLI and in those with persistent lifestyle-limiting claudication despite optimal medical therapy and an exercise program, revascularization is indicated for limb salvage and symptom relief, respectively. Consensus guidelines currently support an endovascular first approach to revascularization in the majority of cases. Surgical procedures provide an alternative to endovascular therapy in select cases. © 2016, Springer Science+Business Media New York (outside the USA).
引用
收藏
相关论文
共 90 条
[1]  
Fowkes F.G.R., Rudan D., Rudan I., Et al., Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis, Lancet, 382, 9901, pp. 1329-1340, (2013)
[2]  
Leng G.C., Lee A.J., Fowkes F.G., Et al., Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population, Int J Epidemiol, 25, 6, pp. 1172-1181, (1996)
[3]  
Pande R.L., Perlstein T.S., Beckman J.A., Creager M.A., Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004, Circulation, 124, 1, pp. 17-23, (2011)
[4]  
Joosten M.M., Pai J.K., Bertoia M.L., Et al., Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men, JAMA, 308, 16, pp. 1660-1667, (2012)
[5]  
Nehler M.R., Duval S., Diao L., Et al., Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population, J Vasc Surg, 60, 3, pp. 686-695, (2014)
[6]  
Dattilo P.B., Casserly I.P., Critical limb ischemia: endovascular strategies for limb salvage, Prog Cardiovasc Dis, 54, 1, pp. 47-60, (2011)
[7]  
Minar E., Critical limb ischaemia, Hamostaseologie, 29, 1, pp. 102-109, (2009)
[8]  
Slovut D.P., Sullivan T.M., Critical limb ischemia: medical and surgical management, Vasc Med Lond Engl, 13, 3, pp. 281-291, (2008)
[9]  
Pipinos I.I., Judge A.R., Selsby J.T., Et al., The myopathy of peripheral arterial occlusive disease: part 1. Functional and histomorphological changes and evidence for mitochondrial dysfunction, Vasc Endovasc Surg, 41, 6, pp. 481-489, (2008)
[10]  
Bertele V., Roncaglioni M.C., Pangrazzi J., Terzian E., Tognoni E.G., Clinical outcome and its predictors in 1560 patients with critical leg ischaemia. Chronic critical Leg ischaemia group, Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg, 18, 5, pp. 401-410, (1999)