PAD 与其他类型动脉粥样硬化性疾病的并发症发病率和死亡率相关,即使在对已知常见危险因素作出调整后依然如此。[19]Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015 Apr 24;116(9):1509-26.http://www.ncbi.nlm.nih.gov/pubmed/25908725?tool=bestpractice.com这解释了 PAD 患者进行一般心血管预防的重要性。[2]Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Circulation. 2017 Mar 21;135(12):e686-e725.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479414/http://www.ncbi.nlm.nih.gov/pubmed/27840332?tool=bestpractice.com
踝臂指数 (ABI) 除了能够诊断 PAD 之外,还是心血管事件的一个标志物。[1]Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur Heart J. 2017 Aug 26 [Epub ahead of print].https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehx095/4095038http://www.ncbi.nlm.nih.gov/pubmed/28886620?tool=bestpractice.comABI 急剧下降预示着全因死亡率和心血管疾病死亡率的预后较差,与基线 ABI 和潜在混杂因素无关。[19]Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015 Apr 24;116(9):1509-26.http://www.ncbi.nlm.nih.gov/pubmed/25908725?tool=bestpractice.com
跛行
跛行症状在很大程度上会保持稳定,不会迅速恶化。ABI 显著降低和糖尿病这两个临床危险因素会增加慢性肢体缺血的风险。[2]Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Circulation. 2017 Mar 21;135(12):e686-e725.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479414/http://www.ncbi.nlm.nih.gov/pubmed/27840332?tool=bestpractice.com
严重肢体缺血
在第 1 年时,有 25% 的严重肢体缺血患者将死亡,30% 的患者将进行截肢。在第 5 年时,超过 60% 的严重肢体缺血患者将死亡。[89]Davies MG. Criticial limb ischemia: epidemiology. Methodist Debakey Cardiovasc J. 2012 Oct-Dec;8(4):10-4.http://www.ncbi.nlm.nih.gov/pubmed/23342182?tool=bestpractice.com
急性肢体缺血
肢体的长期预后取决于在造成永久性组织坏死和神经损害之前,血运重建的速度和彻底程度。