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下肢外周动脉疾病的分类

Author
Joseph L Mills, Sr, MD
Section Editor
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
任为, 主任医师

引言

在选择下肢血运重建术的治疗方案时，必须要权衡特定干预相对于患者疾病的风险与患者临床状况的预期改善(如，疼痛缓解、溃疡愈合、维持能走动和功能状态)，以及该干预在患者预期寿命中的效果持久性[1]。对外周动脉疾病(peripheral artery disease, PAD)的症状及导致这些临床症状的解剖病变进行分级，可提供客观指标，使得临床上可根据这些客观指标来随访患者，重要的是，该分级还可为临床研究比较药物和介入治疗提供一致性指标。对于存在PAD相关症状的患者，为进行保险理赔或确定其是否有资格申请残疾保障项目，可能需要对其受损和失能程度进行量化。

本文将总结有助于指导PAD处理的分类方法。跛行及危重肢体缺血的临床诊断与治疗将在别处讨论。 (参见“下肢外周动脉疾病的临床特征与诊断”和“Surgical management of claudication”和“下肢跛行患者的经皮介入治疗”和“慢性重症下肢缺血的治疗”)

下肢动脉解剖

下肢动脉的解剖学知识对于下肢PAD的分类很重要。

下肢由股总动脉灌注(图 1)。股总动脉分支为股浅动脉和股深动脉。股浅动脉在大腿前方向下走行，位于大腿前区肌群的内收肌和股四头肌之间(图 2)。在股骨远端1/3处，股浅动脉贴近股骨走行。并穿过收肌管延续为腘动脉(图片 1)，腘动脉在胫骨粗隆水平分为胫前动脉和胫腓干，后者再进一步分为胫后动脉和腓动脉(图片 2A-B)。胫前动脉伴随着腓深神经沿着胫骨后缘走行(图 3)。腓动脉全程邻近腓骨内侧缘向远端走行。在小腿后区肌群深处，胫后动脉与胫神经伴行。

下肢的侧支循环来自股深动脉(图 2)。较年轻患者侧支未充分形成，因此在动脉中断后易出现严重的急性缺血。

                          

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-18.
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