Effective treatment and optimal prognosis of peripheral artery disease / 中国组织工程研究

ABSTRACT

OBJECTIVE: Newer medicine therapies have been proved efficacy in patients with intermittent claudication. With rapid advances of intervention devices and techniques for peripheral vessels in recent years, which has improved the therapy of peripheral artery disease (PAD). To review the clinical developments in treatment of PAD so as to provide references for optimal integrated therapy of medicine with proper interventional treatment, which enable PAD patients to achieve the greatest long-term prognosis. DATA SOURCES A computer-based search for literatures related to PAD from 1991 to April 2006 was conducted in Medline databasewith the of "peripheral arterial disease, catheterization, peripheral, genetics", and the language was limited to English. Meanwhile, Chinese relevant literatures between 1994 and April 2006 were searched in Journal Full-text Database and Wanfang Database by computer with the keywords of "peripheral arterial disease, intermittent claudication, management". STUDY SELECTION Primary selection was performed by following inclusive criteria PDA and drug treatment, stent, angioplasty, genetic therapy, surgery, and articles related to PDA were selected. Scientific criteria of treatment for PDA were looked for in basic researches, clinical studies and those published in formal organizations. Exclusive criteria Repetitive studies, reviews and Meta analytical literatures were excluded. DATA EXTRACTION A total of 60 literatures about the treatment for PDA were collected, 30 enrolled articles in which were reviewed. Thirty repetitive studies, reviews and Meta analytical literatures were excluded. DATA SYNTHESIS: ①The prevalence of PAD depends on the diagnosis. Given the inaccuracy of physical examination, use of pulse examination as the sole criterion would grossly overestimate the prevalence. In contrast, a historical query for intermittent claudication would underestimate the prevalence of PAD. The ankle-brachial index (ABI) has been validated by angiography with the sensitivity of 95% and the specificity of 100%.②The risk factors of PAD were similar to those in patients with cardiovascular disease and cerebrovascular disease. The goals of therapy for patients with PAD are to prevent systemic atherosclerotic disease progression and clinical cardiovascular events as well as prevent limb loss and improve the functional status of patients with intermittent caludication.③Medical therapy of PAD should include manipulations of risk factors for atherosclerotic heart disease, including smoke-stopping, body mass reducing, blood glucose controlling, blood pressure controlling and hypercholestermia reducing etc. Instructive exercise therapy is the most effective way in non-interventional therapy, while medicine therapy mainly included antiplatelet therapy, angiotenic therapy and anticoagulation therapy. If the patients has obvious clinical ischemia symptoms and cannot be relieved by medical treatment, then interventional therapy or surgery is necessary. CONCLUSION: Patients with PAD can achieve the best long-term prognosis by an instructive exercise treatment integrated with optimal medicine therapy and proper interventional therapy.