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动脉疾病的无创性诊断

Authors
Emile R Mohler III, MD
Erica Mitchell, MD, FACS
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

引言

动脉疾病患者的评估，开始要进行全面的病史采集和体格检查，并采用无创性血管检查作为辅助检查来确定临床诊断，并进一步明确血管病变的节段和程度。血管检查可适用于根据症状(如间歇性跛行)和体格检查发现(例如组织缺血体征)而怀疑存在动脉疾病的患者或存在动脉粥样硬化危险因素(如吸烟、糖尿病)或其他动脉病变危险因素(如创伤、外周栓塞)的患者[1]。

多种无创性检查方法均可用于评估是否存在动脉疾病及其严重程度。生理学检测包括节段性肢体压力测定和计算压力指数值(例如踝-肱指数、腕-肱指数)、运动试验、节段性容积描记法、经皮血氧测定和光学容积描记法。  

超声检查为主要的影像学方法，根据血管疾病，每种模式(例如B型和双功能)均可提供有用的具体信息。常用于脉管系统成像的其他检查方法，包括计算机断层扫描(computed tomography, CT)和磁共振成像(magnetic resonance imaging, MRI)。CT和MRI是血管评估的重要可选择方法；但这些检查所需成本和时间限制了将其作为常规检查使用[2]。对比动脉造影术仍是血管影像学检查的金标准，有时可作为主要影像学检查方法，尤其在考虑介入治疗的情况下。这些影像学方法在具体血管疾病中的作用将会单独详细讨论(参见“腹主动脉瘤的临床特征与诊断”)。

检查的适应证

是否需要进行无创性血管检查对病史和体格检查结果进行补充，取决于患者疾病的临床情况和紧急程度。并非所有患者都需要接受一整套彻底的检查以评价他们的血管状况。一般而言，应仅进行可证实动脉疾病存在或提供会改变治疗过程信息的检查。

患者可无症状，或存在外周动脉疾病(peripheral artery disease, PAD)的典型症状(如跛行)，或存在更不典型的症状。症状因以下因素而不同：受累的血管床、疾病的性质和严重程度，以及侧支循环是否存在及其有效性。各种血管疾病的临床表现将在单独的专题中讨论。 (参见“下肢外周动脉疾病的临床特征与诊断”和“胸廓出口综合征概述”和“雷诺现象的临床表现和诊断”和“腹主动脉瘤的临床特征与诊断”)

                      

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-28.
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