外周动脉疾病的治疗进展
|
摘要
外周动脉疾病(PAD)与吸烟、糖尿病等关系密切,随着诊断技术的逐步提升,PAD的治疗也在不断变化。目前PAD的治疗主要有药物治疗、干细胞治疗、血运重建治疗及运动和电刺激治疗。PAD的药物治疗以抗血小板为主,通过抗血小板治疗可抑制血小板聚集,减少缺血风险,改善下肢缺血症状,还可以降低患者心血管不良事件的发生率。干细胞治疗可以从已经存在的血管诱导生成新的血管。血运重建治疗可以恢复血流,明显减少截肢事件的发生。运动治疗和电刺激治疗可以改善患者运动能力,改善生活质量和功能状态。
Peripheral arterial disease( PAD) is closely related to smoking,diabetes and so on. With the gradual improvement of diagnostic technology,the treatment of PAD is also changing. At present,the treatment of PAD includes drug therapy,stem cell therapy,revascularization therapy,exercise and electrical therapy. The drug treatment of PAD is mainly antiplatelet,which can inhibit platelet aggregation,reduce the risk of ischemia,improve the symptoms of lower limb ischemia,and reduce the incidence of adverse cardiovascular events in patients. Stem cell therapy can induce new blood vessels from existing vessels. Revascularization can restore blood flow and significantly reduce amputation events. Exercise therapy and electrical stimulation therapy can improve exercise capacity,quality of life and functional status of the patients.
Peripheral arterial disease( PAD) is closely related to smoking,diabetes and so on. With the gradual improvement of diagnostic technology,the treatment of PAD is also changing. At present,the treatment of PAD includes drug therapy,stem cell therapy,revascularization therapy,exercise and electrical therapy. The drug treatment of PAD is mainly antiplatelet,which can inhibit platelet aggregation,reduce the risk of ischemia,improve the symptoms of lower limb ischemia,and reduce the incidence of adverse cardiovascular events in patients. Stem cell therapy can induce new blood vessels from existing vessels. Revascularization can restore blood flow and significantly reduce amputation events. Exercise therapy and electrical stimulation therapy can improve exercise capacity,quality of life and functional status of the patients.
引文
[1]李觉,乔永霞,孙英贤,等.踝臂指数诊断下肢动脉疾病的敏感性和特异性[J].中华老年医学杂志,2008,27(9):641-644.
[2]Armstrong EJ,Wu J,Singh GD,et al.Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease[J].J Vasc Surg,2014,60(6):1565-1571.
[3]Rooke TW,Hirsch AT,Misra S,et al.Management of patients with peripheral artery disease(compilation of 2005 and 2011ACCF/AHA guideline recommendations):A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61(14):1555-1570.
[4]Vos CG,Vahl AC.Anticoagulation and antiplatelet therapy in patients with peripheral arterial disease of the femoropopliteal arteries[J].J Cardiovasc Surg(Torino),2018,59(2):164-171.
[5]Kronlage M,Wassmann M,Vogel B,et al.Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries[J].Drug Des Devel Ther,2017,11:2937-2945.
[6]Secemsky EA,Yeh RW,Kereiakes DJ,et al.Extended duration dual antiplatelet therapy after coronary stenting among patients with peripheral arterial disease:A subanalysis of the dual antiplatelet therapy study[J].JACC Cardiovasc Interv,2017,10(9):942-954.
[7]Bhal V,Herr MJ,Dixon M,et al.Platelet function recovery following exposure to triple anti-platelet inhibitors using an in vitro transfusion model[J].Thromb Res,2015,136(6):1216-1223.
[8]Morrow DA,Braunwald E,Bonaca MP,et al.Vorapaxar in the secondary prevention of atherothrombotic events[J].N Engl J Med,2012,366(15):1404-1413.
[9]Bonaca MP,Gutierrez JA,Creager MA,et al.Acute limb ischemia and outcomes with vorapaxar in patients with peripheral artery disease:Results from the trial to assess the effects of vorapaxar in preventing heart attack and stroke in patients with atherosclerosisthrombolysis in myocardial infarction 50(TRA2°P-TIMI 50)[J].Circulation,2016,133(10):997-1005.
[10]Baker NC,Lipinski MJ,Lhermusier T,et al.Overview of the 2014food and drug administration cardiovascular and renal drugs advisory committee meeting about vorapaxar[J].Circulation,2014,130(15):1287-1294.
[11]Jeng JS,Sun Y,Lee JT,et al.The efficacy and safety of cilostazol in ischemic stroke patients with peripheral arterial disease(SPAD):Protocol of a randomized,double-blind,placebo-controlled multicenter trial[J].Int J Stroke,2015,10(1):123-127.
[12]Bonaca MP,Bhatt DL,Storey RF,et al.Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease[J].J Am Coll Cardiol,2016,67(23):2719-2728.
[13]Hiatt WR,Fowkes FG,Heizer G,et al.Ticagrelor versus clopidogrel in symptomatic peripheral artery disease[J].N Engl J Med,2017,376(1):32-40.
[14]Jones WS,Baumgartner I,Hiatt WR,et al.Ticagrelor compared with clopidogrel in patients with prior lower extremity revascularization for peripheral artery disease[J].Circulation,2017,135(3):241-250.
[15]Heart Outcomes Prevention Evaluation Study Investigators,Yusuf S,Sleight P,et al.Effects of an angiotensin-converting enzyme inhibitor,ramipril,on cardiovascular events in high-risk patients[J].N Engl J Med,2000,342(3):145-153.
[16]Arya S,Khakharia A,Binney ZO,et al.Association of statin dose with amputation and survival in patients with peripheral artery disease[J].Circulation,2018137(14):1435-1446.
[17]Kawamoto A,Katayama M,Handa N,et al.Intramuscular transplantation of G-CSF mobilized CD34+cells in patients with critical limb ischemia:A phaseⅠ/Ⅱa,multicenter,single-blinded,dose-escalation clinical trial[J].Stem Cells,2009,27(11):2857-2864.
[18]Burt RK,Testori A,Oyama Y,et al.Autologous peripheral blood CD133+cell implantation for limb salvage in patients with critical limb ischemia[J].Bone Marrow Transplantation,2010,45(1):111-116.
[19]Walter DH,Krankenberg H,Balzer JO,et al.Intraarterial administration of bone marrow mononuclear cells in patients with critical limb ischemia:A randomized-start,placebo-controlled pilot trial(PROVASA)[J].Circ Cardiovasc Interv,2011,4(1):26-37.
[20]Murphy MP,Lawson JH,Rapp BM,et al.Autologous bone marrow mononuclear cell therapy is safe and promotes amputation-free survival in patients with critical limb ischemia[J].J Vasc Surg,2011,53(6):1565-1574.e1.
[21]Amann B,Luedemann C,Ratei R,et al.Autologous bone marrow cell transplantation increases leg perfusion and reduced amputations in patients with advanced critical limb ischemic due to peripheral artery disease[J].Cell Transplant,2009,18(3):371-380.
[22]Lasala GP,Silva JA,Gardner PA,et al.Combination stem cell therapy for the treatment of severe limb ischemia:Safety and efficacy analysis[J].Angiology,2010,61(6):551-556.
[23]Lasala GP,Silva JA,Minguell JJ.Therapeutic angiogenesis in patients with severe limb ischemia by transplantation of a combination stem cell product[J].J Thorac Cardiovasc Surg,2012,144(2):377-382.
[24]庄稼英.2011年PAD管理指南主要更新[J].糖尿病天地·临床(下旬),2012,6(1):6-11.
[25]European Stroke Organisation,Tendera M,Aboyans V,et al.ESC Guidelines on the diagnosis and treatment of peripheral artery diseases:Document covering atherosclerotic disease of extracranial carotid and vertebral,mesenteric,renal,upper and lower extremity arteries:The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology(ESC)[J].Eur Heart J,2011,32(22):2851-2906.
[26]张晶,何菊,杨森,等.下肢动脉硬化性闭塞症多节段复杂病变的杂交手术治疗[J].心肺血管病杂志,2010,29(6):471-473,479.
[27]Heikkila K,Mitchell DC,Loftus IM,et al.Improving 1-year outcomes of infrainguinal limb revascularisation:A population-based cohort study of 104 000 patients in England[J].Circulation,2018,137(18):1921-1933.
[28]包俊敏.下肢重症肢体缺血腔内治疗思路及血管灌注区段(Angiosome)概念的应用[J].中国微创外科杂志,2013,13(9):774-776.
[29]Zheng XT,Zeng RC,Huang JY,et al.The use of the angiosome concept for treating infrapopliteal critical limb ischemia through interventional therapy and determining the clinical significance of collateral vessels[J].Ann Vasc Surg,2016,32:41-49.
[30]Hirsch AT,Duval S.Effective vascular therapeutics for critical limb ischemia:A role for registry-based clinical investigation[J].Circ Cardiovasc Interv,2013,6(1):8-11.
[31]Malyar N,Fürstenberg T,Wellmann J,et al.Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease:A nationwide population-based analysis[J].Eur Heart J,2013,34(34):2706-2714.
[32]Reinecke H,Unrath M,Freisinger E,et al.Peripheral arterial disease and critical limb ischaemia:Still poor outcomes and lack of guideline adherence[J].Eur Heart J,2015,36(15):932-938.
[33]张婷,张岚.运动处方在外周动脉疾病患者中的应用与进展[J].介入放射学杂志,2017,26(6):568-571.
[34]Murphy TP,Cutlip DE,Regensteiner JG,et al.Supervised exercise,stent revascularization,or medical therapy for claudication due to aortoiliac peripheral artery disease:the CLEVER study[J].J Am Coll Cardiol,2015,65(10):999-1009.
[35]Anderson SI,Whatling P,Hudlicka O,et al.Chronic transcutaneous electrical stimulation of calf muscles improves functional capacity without inducing systemic inflammation in claudicants[J].Eur J Vasc Endovasc Surg,2004,27(2):201-209.
[36]Sluka KA,Bjordal JM,Marchand S,et al.What makes transcutaneous electrical nerve stimulation work Making sense of the mixed results in the clinical literature[J].Phys Ther,2013,93(10):1397-1402.
[37]Besnier F,Sénard JM,Grémeaux V,et al.The efficacy of transcutaneous electrical nerve stimulation on the improvement of walking distance in patients with peripheral arterial disease with intermittent claudication:Study protocol for a randomised controlled trial:the TENS-PAD study[J].Trials,2017,18(1):373.
[38]Yarboro DD,Smith R.Transcutaenous electrical nerve stimulation to manage a lower extremity wound complicated by peripheral arterial disease:A case report[J].Ostomy Wound Manage,2014,60(7):40-45.
[2]Armstrong EJ,Wu J,Singh GD,et al.Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease[J].J Vasc Surg,2014,60(6):1565-1571.
[3]Rooke TW,Hirsch AT,Misra S,et al.Management of patients with peripheral artery disease(compilation of 2005 and 2011ACCF/AHA guideline recommendations):A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61(14):1555-1570.
[4]Vos CG,Vahl AC.Anticoagulation and antiplatelet therapy in patients with peripheral arterial disease of the femoropopliteal arteries[J].J Cardiovasc Surg(Torino),2018,59(2):164-171.
[5]Kronlage M,Wassmann M,Vogel B,et al.Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries[J].Drug Des Devel Ther,2017,11:2937-2945.
[6]Secemsky EA,Yeh RW,Kereiakes DJ,et al.Extended duration dual antiplatelet therapy after coronary stenting among patients with peripheral arterial disease:A subanalysis of the dual antiplatelet therapy study[J].JACC Cardiovasc Interv,2017,10(9):942-954.
[7]Bhal V,Herr MJ,Dixon M,et al.Platelet function recovery following exposure to triple anti-platelet inhibitors using an in vitro transfusion model[J].Thromb Res,2015,136(6):1216-1223.
[8]Morrow DA,Braunwald E,Bonaca MP,et al.Vorapaxar in the secondary prevention of atherothrombotic events[J].N Engl J Med,2012,366(15):1404-1413.
[9]Bonaca MP,Gutierrez JA,Creager MA,et al.Acute limb ischemia and outcomes with vorapaxar in patients with peripheral artery disease:Results from the trial to assess the effects of vorapaxar in preventing heart attack and stroke in patients with atherosclerosisthrombolysis in myocardial infarction 50(TRA2°P-TIMI 50)[J].Circulation,2016,133(10):997-1005.
[10]Baker NC,Lipinski MJ,Lhermusier T,et al.Overview of the 2014food and drug administration cardiovascular and renal drugs advisory committee meeting about vorapaxar[J].Circulation,2014,130(15):1287-1294.
[11]Jeng JS,Sun Y,Lee JT,et al.The efficacy and safety of cilostazol in ischemic stroke patients with peripheral arterial disease(SPAD):Protocol of a randomized,double-blind,placebo-controlled multicenter trial[J].Int J Stroke,2015,10(1):123-127.
[12]Bonaca MP,Bhatt DL,Storey RF,et al.Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease[J].J Am Coll Cardiol,2016,67(23):2719-2728.
[13]Hiatt WR,Fowkes FG,Heizer G,et al.Ticagrelor versus clopidogrel in symptomatic peripheral artery disease[J].N Engl J Med,2017,376(1):32-40.
[14]Jones WS,Baumgartner I,Hiatt WR,et al.Ticagrelor compared with clopidogrel in patients with prior lower extremity revascularization for peripheral artery disease[J].Circulation,2017,135(3):241-250.
[15]Heart Outcomes Prevention Evaluation Study Investigators,Yusuf S,Sleight P,et al.Effects of an angiotensin-converting enzyme inhibitor,ramipril,on cardiovascular events in high-risk patients[J].N Engl J Med,2000,342(3):145-153.
[16]Arya S,Khakharia A,Binney ZO,et al.Association of statin dose with amputation and survival in patients with peripheral artery disease[J].Circulation,2018137(14):1435-1446.
[17]Kawamoto A,Katayama M,Handa N,et al.Intramuscular transplantation of G-CSF mobilized CD34+cells in patients with critical limb ischemia:A phaseⅠ/Ⅱa,multicenter,single-blinded,dose-escalation clinical trial[J].Stem Cells,2009,27(11):2857-2864.
[18]Burt RK,Testori A,Oyama Y,et al.Autologous peripheral blood CD133+cell implantation for limb salvage in patients with critical limb ischemia[J].Bone Marrow Transplantation,2010,45(1):111-116.
[19]Walter DH,Krankenberg H,Balzer JO,et al.Intraarterial administration of bone marrow mononuclear cells in patients with critical limb ischemia:A randomized-start,placebo-controlled pilot trial(PROVASA)[J].Circ Cardiovasc Interv,2011,4(1):26-37.
[20]Murphy MP,Lawson JH,Rapp BM,et al.Autologous bone marrow mononuclear cell therapy is safe and promotes amputation-free survival in patients with critical limb ischemia[J].J Vasc Surg,2011,53(6):1565-1574.e1.
[21]Amann B,Luedemann C,Ratei R,et al.Autologous bone marrow cell transplantation increases leg perfusion and reduced amputations in patients with advanced critical limb ischemic due to peripheral artery disease[J].Cell Transplant,2009,18(3):371-380.
[22]Lasala GP,Silva JA,Gardner PA,et al.Combination stem cell therapy for the treatment of severe limb ischemia:Safety and efficacy analysis[J].Angiology,2010,61(6):551-556.
[23]Lasala GP,Silva JA,Minguell JJ.Therapeutic angiogenesis in patients with severe limb ischemia by transplantation of a combination stem cell product[J].J Thorac Cardiovasc Surg,2012,144(2):377-382.
[24]庄稼英.2011年PAD管理指南主要更新[J].糖尿病天地·临床(下旬),2012,6(1):6-11.
[25]European Stroke Organisation,Tendera M,Aboyans V,et al.ESC Guidelines on the diagnosis and treatment of peripheral artery diseases:Document covering atherosclerotic disease of extracranial carotid and vertebral,mesenteric,renal,upper and lower extremity arteries:The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology(ESC)[J].Eur Heart J,2011,32(22):2851-2906.
[26]张晶,何菊,杨森,等.下肢动脉硬化性闭塞症多节段复杂病变的杂交手术治疗[J].心肺血管病杂志,2010,29(6):471-473,479.
[27]Heikkila K,Mitchell DC,Loftus IM,et al.Improving 1-year outcomes of infrainguinal limb revascularisation:A population-based cohort study of 104 000 patients in England[J].Circulation,2018,137(18):1921-1933.
[28]包俊敏.下肢重症肢体缺血腔内治疗思路及血管灌注区段(Angiosome)概念的应用[J].中国微创外科杂志,2013,13(9):774-776.
[29]Zheng XT,Zeng RC,Huang JY,et al.The use of the angiosome concept for treating infrapopliteal critical limb ischemia through interventional therapy and determining the clinical significance of collateral vessels[J].Ann Vasc Surg,2016,32:41-49.
[30]Hirsch AT,Duval S.Effective vascular therapeutics for critical limb ischemia:A role for registry-based clinical investigation[J].Circ Cardiovasc Interv,2013,6(1):8-11.
[31]Malyar N,Fürstenberg T,Wellmann J,et al.Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease:A nationwide population-based analysis[J].Eur Heart J,2013,34(34):2706-2714.
[32]Reinecke H,Unrath M,Freisinger E,et al.Peripheral arterial disease and critical limb ischaemia:Still poor outcomes and lack of guideline adherence[J].Eur Heart J,2015,36(15):932-938.
[33]张婷,张岚.运动处方在外周动脉疾病患者中的应用与进展[J].介入放射学杂志,2017,26(6):568-571.
[34]Murphy TP,Cutlip DE,Regensteiner JG,et al.Supervised exercise,stent revascularization,or medical therapy for claudication due to aortoiliac peripheral artery disease:the CLEVER study[J].J Am Coll Cardiol,2015,65(10):999-1009.
[35]Anderson SI,Whatling P,Hudlicka O,et al.Chronic transcutaneous electrical stimulation of calf muscles improves functional capacity without inducing systemic inflammation in claudicants[J].Eur J Vasc Endovasc Surg,2004,27(2):201-209.
[36]Sluka KA,Bjordal JM,Marchand S,et al.What makes transcutaneous electrical nerve stimulation work Making sense of the mixed results in the clinical literature[J].Phys Ther,2013,93(10):1397-1402.
[37]Besnier F,Sénard JM,Grémeaux V,et al.The efficacy of transcutaneous electrical nerve stimulation on the improvement of walking distance in patients with peripheral arterial disease with intermittent claudication:Study protocol for a randomised controlled trial:the TENS-PAD study[J].Trials,2017,18(1):373.
[38]Yarboro DD,Smith R.Transcutaenous electrical nerve stimulation to manage a lower extremity wound complicated by peripheral arterial disease:A case report[J].Ostomy Wound Manage,2014,60(7):40-45.