外周动脉疾病与其诊断方法.ppt

There is a strong two-way association between decreased ABI and increased risk for cardiovascular death There is a clear association between the extent of PAD and the risk of myocardial infarction (MI) and stroke1. Reference: Dormandy JA, Creager MA. Ankle: arm blood pressure index as a predictor of atherothrombotic events: evidence from CAPRIE. Cerebrovasc Dis 1999; 9(suppl 1): 14. The American Diabetes Association recommends screening for PAD in patients with diabetes In patients with type 2 diabetes, peripheral arterial disease (PAD) is a major contributor to diabetic foot problems. Common foot problems include loss of feeling in feet, changes in the shape of feet, infection, ulceration, or gangrene that may lead, in severe cases, to amputation of a toe, foot or leg. Further, prevention of foot problems may be easier than treating foot problems. Risk factor management approach All patients with peripheral arterial disease (PAD), regardless of severity, should undergo risk-factor modification to achieve desired levels of cholesterol, blood pressure, and plasma glucose control. Smoking cessation has been shown to slow the progression of PAD to critical limb ischemia and reduce the risk of myocardial infarction and death from vascular causes.1 Lowering cholesterol levels in patients with coronary artery disease has also produced benefits in patients with PAD. Statins not only reduce cholesterol levels, they may also improve endothelial function. Intensive control of blood glucose levels prevents the microvascular complications of diabetes and should be adhered to in patients with PAD. Blood pressure reduction is also very important in this high risk group of patients and aggressive treatment of hypertension is warranted. In addition to lowering blood pressure, angiotensin converting enzyme inhibitors may confer additional protection against cardiovascular events independent of blood pressure lowering and can reduce renal complications in pa