治疗性血管再生
治疗性血管再生（予以血管生长因子）已成为 PAD 患者的一种可能的替代治疗选择。初步证据显示，严重肢体缺血 PAD 患者接受自体骨髓单核细胞移植可能改善下肢缺血症状。[79]Paraskevas KI, Mikhailidis DP. Angiogenesis: a promising treatment option for peripheral arterial disease. Curr Vasc Pharmacol. 2008Apr;6(2):78-80.http://www.ncbi.nlm.nih.gov/pubmed/18393907?tool=bestpractice.com[80]Fadini GP, Agostini C, Avogaro A. Autologous stem cell therapy for peripheral arterial disease: meta-analysis and systematic review of the literature. Atherosclerosis. 2010 Mar;209(1):10-7.http://www.ncbi.nlm.nih.gov/pubmed/19740466?tool=bestpractice.com 这一结论也得到两项系统性综述结果的支持。[81]Moazzami K, Moazzami B, Roohi A, et al. Local intramuscular transplantation of autologous mononuclear cells for critical lower limb ischaemia. Cochrane Database Syst Rev. 2014 Dec 7;(12):CD008347.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008347.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/22161427?tool=bestpractice.com[82]Teraa M, Sprengers RW, van der Graaf Y, et al. Autologous bone marrow-derived cell therapy in patients with critical limb ischemia: a meta-analysis of randomized controlled clinical trials. Ann Surg. 2013 Dec;258(6):922-9.http://www.ncbi.nlm.nih.gov/pubmed/23426345?tool=bestpractice.com 但是，在得到确切的结论之前，仍需要更大型研究提供更多的数据。
球囊导管
美国食品药品监督管理局 (FDA) 已批准 Lutonix® 035 药物涂层球囊经皮腔内血管成形术 (PTA) 导管、IN.PACT Admiral® 紫杉醇涂层 PTA 球囊导管和 Stellarex® 药物涂层血管成形术球囊用于治疗股腘病变。[83]Food and Drug Administration. FDA approves first drug-coated angioplasty balloon catheter to treat vascular disease. October 2014 [internet publication].[84]Food and Drug Administration. Medtronic IN.PACT Admiral Paclitaxel-coated PTA balloon catheter – P140010. December 2014 [internet publication].https://www.accessdata.fda.gov/cdrh_docs/pdf14/P140010c.pdf[85]Rosenfield K, Jaff MR, White CJ, et al. Trial of a paclitaxel-coated balloon for femoropopliteal artery disease. N Engl J Med. 2015 Jul 9;373(2):145-53.http://www.nejm.org/doi/full/10.1056/NEJMoa1406235http://www.ncbi.nlm.nih.gov/pubmed/26106946?tool=bestpractice.com[86]Tepe G, Laird J, Schneider P, et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015 Feb 3;131(5):495-502.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323569/http://www.ncbi.nlm.nih.gov/pubmed/25472980?tool=bestpractice.com 这些药物涂层球囊可能改善长期血管成形术结局，无需永久性支架植入物。
沃拉帕沙
凝血酶受体拮抗剂作为一种强效的抗血小板药物。针对近期心肌梗死或 PAD 患者的临床试验显示，在阿司匹林和/或氯吡格雷的用药基础上加用沃拉帕沙 (vorapaxar) 可减少长期随访期间的主要不良心血管事件。对 PAD 患者的亚组分析也表明，沃拉帕沙可减少急性肢体缺血的发生。[87]Gryka RJ, Buckley LF, Anderson SM. Vorapaxar: the current role and future directions of a novel protease-activated receptor antagonist for risk reduction in atherosclerotic disease. Drugs R D. 2017 Mar;17(1):65-72.http://www.ncbi.nlm.nih.gov/pubmed/28063023?tool=bestpractice.com
利伐沙班
利伐沙班是一种直接作用的口服抗凝剂，可抑制 Xa 因子。现已被广泛研究用于静脉血栓栓塞的治疗以及房颤患者的卒中预防。一项大型、多国、随机临床试验表明，在小剂量阿司匹林治疗中加用利伐沙班，可减少 PAD 患者主要不良心血管事件和主要不良肢体事件的发生几率。[88]Eikelboom JW, Connolly SJ, Bosch J, et al; COMPASS Investigators. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017 Oct 5;377(14):1319-30.http://www.ncbi.nlm.nih.gov/pubmed/28844192?tool=bestpractice.com
