Lower-limb peripheral arterial disease and amputations in people with diabetes: Risk factors, prognostic value and management

IF 3.2 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Ninon Foussard , Loubna Dari , Eric Ducasse , Vincent Rigalleau , Kamel Mohammedi , Caroline Caradu
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引用次数: 3

Abstract

Lower-limb peripheral arterial disease (PAD), is a common manifestation of systemic atherosclerosis, resulting from a partial or complete obstruction of at least one lower-limb arteries. PAD is a major endemic disease with an excess risk of major cardiovascular events and death. It also leads to disability, high rates of lower-limb adverse events and non-traumatic amputation. In patients with diabetes, PAD is particularly frequent and has a worse prognosis than in patients without diabetes. The risk factors of PAD are comparable to those for cardiovascular disease. The ankle-brachial index is usually recommended to screen PAD despite its limited performance in patients with diabetes, affected by the presence of peripheral neuropathy, medial arterial calcification, incompressible arteries and infection. Toe brachial index and toe pressure emerge as alternative screening tools. The management of PAD requires strict control of cardiovascular risk factors including diabetes, hypertension and dyslipidaemia, the use of antiplatelet agents and lifestyle management, to reduce cardiovascular adverse events, but few randomized controlled trials have evaluated the benefits of these treatments in PAD. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in PAD prognosis. Further studies are required to increase our understanding of the pathophysiology of PAD and to evaluate the interest of different therapeutic strategies in the occurrence and progression of PAD in patients with diabetes. Here, we present a narrative and contemporary review to synthesize the key epidemiology findings, screening and diagnosis methods, and major therapeutic advances regarding PAD in patients with diabetes.

糖尿病患者下肢外周动脉疾病和截肢:危险因素、预后价值和处理
下肢外周动脉疾病(PAD)是系统性动脉粥样硬化的常见表现,由至少一条下肢动脉的部分或完全阻塞引起。PAD是一种主要的地方病,发生重大心血管事件和死亡的风险过高。它还导致残疾、下肢不良事件发生率高以及非创伤性截肢。在糖尿病患者中,PAD特别常见,并且预后比无糖尿病患者差。PAD的危险因素与心血管疾病的危险因素相当。踝臂指数通常被推荐用于筛查PAD,尽管它在糖尿病患者中的表现有限,受周围神经病变、内侧动脉钙化、不可压缩动脉和感染的影响。趾臂指数和脚趾压力作为替代筛查工具出现。PAD的管理需要严格控制心血管风险因素,包括糖尿病、高血压和血脂异常,使用抗血小板药物和生活方式管理,以减少心血管不良事件,但很少有随机对照试验评估这些治疗对PAD的益处。血管内和外科血运重建手术取得了一些进展,PAD预后明显改善。需要进一步的研究来增加我们对PAD病理生理学的理解,并评估不同治疗策略对糖尿病患者PAD发生和发展的兴趣。在此,我们对糖尿病患者PAD的关键流行病学发现、筛查和诊断方法以及主要治疗进展进行了综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Presse Medicale
Presse Medicale 医学-医学:内科
自引率
3.70%
发文量
40
审稿时长
43 days
期刊介绍: Seule revue médicale "généraliste" de haut niveau, La Presse Médicale est l''équivalent francophone des grandes revues anglosaxonnes de publication et de formation continue. A raison d''un numéro par mois, La Presse Médicale vous offre une double approche éditoriale : - des publications originales (articles originaux, revues systématiques, cas cliniques) soumises à double expertise, portant sur les avancées médicales les plus récentes ; - une partie orientée vers la FMC, vous propose une mise à jour permanente et de haut niveau de vos connaissances, sous forme de dossiers thématiques et de mises au point dans les principales spécialités médicales, pour vous aider à optimiser votre formation.
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