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下肢外周动脉疾病的临床特征与诊断

Authors
David G Neschis, MD
Michael A Golden, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Denis L Clement, MD, PhD
Emile R Mohler III, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
任为, 主任医师

引言

外周动脉疾病(peripheral artery disease, PAD)，即引起外周动脉阻塞的动脉粥样硬化病，可能无症状或可能表现为提示肢体缺血的多种症状和体征。动脉供血不足(无论什么原因)的临床表现是由于相对于肌肉组织代谢的供血不足，导致受累肌群疼痛。肢体溃疡是肢体缺血所致的较为明显体征之一，而对于其他症状如跛行和静息痛，应积极寻找并将其与非动脉粥样硬化和非血管性病症相鉴别，以确保需要时及时转诊至血管专家处。理想情况下，包括初级保健医护人员、内科医生、足科医生、血管专科医生(介入医师和/或外科医生)和整形外科医生在内的多学科方法可为患者提供最佳的药物和手术治疗。PAD是一种可治疗疾病。早期发现和恰当处理PAD可使引起截肢的并发症减至最少。

本文将总结下肢PAD的临床特征与诊断。PAD的流行病学、危险因素和自然病程，以及PAD的药物及手术治疗将在别处讨论。 (参见“外周动脉疾病的流行病学、危险因素及自然病程”和“Surgical management of claudication”和“下肢跛行患者的经皮介入治疗”)

大多数PAD患者存在下肢动脉粥样硬化性疾病。上肢动脉粥样硬化性PAD相对罕见，并将在别处讨论。 (参见“上肢外周动脉疾病的概述”)

外周动脉疾病

许多病理过程可导致动脉闭塞，从而引发血流减少，继而出现动脉供血不足的症状。在本专题中，我们将重点讨论动脉粥样硬化作为下肢动脉进行性狭窄的原因，或作为动脉粥样硬化栓塞的来源。

用于指代动脉粥样硬化所致动脉疾病的术语有过多种。以前使用过的名称包括动脉硬化性疾病、外周动脉闭塞性疾病。在大多数相关资源中，外周动脉疾病(PAD)这一术语被视为一个通用术语，指一系列由于多种病理生理学过程而改变了主动脉和外周动脉结构和功能，继而导致的非冠状动脉综合征[1-3]。我们使用PAD这一术语指代动脉粥样硬化引起累及外周(非冠状)血管的动脉疾病，与其他病理生理学过程引发外周动脉阻塞相区分，其他外周动脉阻塞将在下文描述并将在其他专题中讨论。 (参见下文‘动脉阻塞的其他原因’)

                                       

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-18.
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