降低外周动脉疾病截肢风险的新路线图

Early diagnosis and treatment of peripheral artery disease is key to preventing amputations and other cardiovascular complications, 根据 new 的指导方针 that also emphasize the importance of coordinated care from a multispecialty team.

“因为PAD的复杂性, 改善这些患者的预后并降低肢体丧失的风险, a multispecialty care team approach that is focused on comprehensively addressing risk factor management, foot care and revascularization is needed to promote collaboration and avoid duplication of care and optimize patient outcomes," Dr. Heather Gornik, chair of the writing committee for the new 的指导方针, said in a news release. Gornik is co-director of the Vascular Center at the University Hospitals Harrington Heart & 克利夫兰血管研究所.

的 的指导方针 provide detailed diagnostic and treatment recommendations for the disease's four clinical presentations in the legs and feet: asymptomatic, meaning there are no symptoms; chronic symptomatic; and its two severe forms that threaten the limbs. 的y were published Tuesday in the 美国心脏协会 journal Circulation and the Journal of the American College of Cardiology.

外周动脉疾病, 或垫, primarily occurs when a buildup of fatty plaque – known as atherosclerosis – narrows the blood vessels and reduces blood flow to the legs and feet. This can significantly impair physical function, the ability to walk and quality of life.

据估计，美国有1000万至1200万成年人患有糖尿病.S. age 40 and older have PAD, which increases the risk of amputation, heart attack, stroke and death. 风险因素包括1型或2型糖尿病, 吸烟, 高血压, 慢性肾病, 身体其他部位有动脉粥样硬化，年龄在75岁以上. Nearly half of people 65 and older who had a limb amputated because of PAD died within a year of surgery, 根据 啊哈统计.

降低截肢风险，预防重大心血管沙巴体育平台点击进入, evidence supports prescribing medications that prevent blood clotting and lower blood pressure and blood glucose levels. 根据新的指导方针, all people with PAD also should be treated with high-intensity statin therapy to lower cholesterol levels. 对于那些没有出血风险的人, the 的指导方针 support treatment with a combination of low-dose aspirin and low-dose rivaroxaban.

People who have or are at risk f或垫 should be encouraged to quit 吸烟 or using tobacco products.

对于那些有PAD症状的人，建议进行有组织的运动治疗. This includes community- and home-based programs as well as those delivered in a clinic or hospital setting. Numerous studies have shown such programs improve a person's ability to walk and raise their quality of life more than standard care.

有监督的运动疗法被认为是PAD患者的“黄金标准”, but it "is woefully underutilized despite its known health benefits and the fact that it is covered by Medicare and most health insurance plans,戈尔尼克说. 据估计，在美国，只有不到5%的PAD患者.S. 是否被要求参加一个有组织、有监督的锻炼计划."

对于患有PAD和1型或2型糖尿病的人, 该指南建议协调治疗以解决饮食问题, 锻炼, 体重管理, medications to control blood sugar and management of other cardiovascular risk factors, 定期检查足部，预防足部溃疡.

该声明强调足部护理对所有PAD患者至关重要, 不管病情有多严重, 应该包括病人教育, 预防性护理和更深入的伤口护理.

有些PAD患者最初不会出现任何症状. 但如果不及时治疗, 这种疾病可以发展成更严重的形式, 包括慢性肢体缺血和急性肢体缺血, both of which occur when severe blockages in the leg arteries prevent proper blood flow. 这会导致腿部疼痛, 即使在休息时, impair physical function and significantly increase the risk for amputations and even death.

对于患有严重PAD的人来说, 及时诊断和治疗对于防止组织丢失和保留肢体至关重要. 这可能包括重建病变动脉的血运重建术. 可能需要其他手术来保持血液流向四肢, 治愈伤口, 减轻疼痛, 保持行走能力，防止截肢.

该指南指出，美国的黑人成年人.S. 经历了更高的发病率和更糟糕的预后. 的y have a 30% lifetime risk of developing the condition, compared to 19% for their white peers. 在黑人成年人中，这种疾病通常在较晚期才被诊断出来, 谁的主要肢体截肢率要高出四倍, 心脏病死亡率高30%中风率高45%.

的 higher rates for racial and ethnic groups may be affected by disparities in housing, 获得保健的机会, education and socioeconomic status – factors considered social determinants of health.

“种族和民族差异的检测, 长期以来，PAD的管理和健康结果一直存在于美国.S. 是一个需要解决的重要公共卫生问题，”戈尔尼克说. "的se disparities highlight opportunities for initiatives focused on early disease detection and improving access to effective PAD treatments for people in under-resourced, 高危社区."

的 guideline writing committee emphasized the need to address disparities in amputation and revascularization procedures and to improve outcomes for all people with PAD.

“认识到这一点很重要 PAD的症状和体征 and move quickly to initiate treatment to improve outcomes and reduce risks,戈尔尼克说. “有了这些更新的指导方针, we have the tools necessary to make a positive impact on outcomes in our patients with PAD. 现在，我们需要共同努力，尽可能广泛地实施它们."