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慢性重症下肢缺血的治疗

Authors
David G Neschis, MD
Michael A Golden, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
郭宏杰, 副主任医师

引言和定义

800万-1000万美国人患有动脉闭塞性疾病，每年每100万人中大约有500-1000例慢性肢体缺血的新发病例[1]。重症缺血的患者可表现出静息痛或组织缺失。静息痛是指在休息时跖骨头底部的疼痛(足远端部疼痛)，静息痛可在患者坐在椅子上腿部悬垂时得以缓解；而组织缺失可为发生在下肢的溃疡、干性坏疽或湿性坏疽，由髂动脉、股动脉或腘动脉的动脉粥样硬化性闭塞性疾病所致[1]。无创性检查中重症肢体缺血的体征包括：踝-肱指数(ankle-brachial index, ABI)小于0.4、脉量记录呈现平坦波形和双功超声检查显示足部低血流或无血流[2]。

根据血管病变的部位和特定的临床情况，重症肢体缺血的不同治疗方法将总结在此。本病和急性肢体缺血的临床表现和诊断将单独讨论。 (参见“急性肢体动脉闭塞(急性肢体缺血)概述”)

一般原则

50岁或以上的外周动脉疾病(peripheral arterial disease, PAD)患者中有1%-2%会发生威胁肢体的缺血[2]。除非采取了能改善动脉灌注的干预措施，否则重症肢体缺血的自然病程通常会不可避免地发展至截肢。相比之下，轻度和中度跛行的自然病程常为良性。 (参见“下肢外周动脉疾病的临床特征与诊断”)

美国心脏病学会(American College of Cardiology, ACC)/美国心脏协会(American Heart Association, AHA)实践指南提示，这些患者在1年时的结局分布如下[2,3]：

●存活并且双下肢均存在–50%

                                    

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Literature review current through: 2017-06 . | This topic last updated: 2015-07-17.
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