Síndrome de isquemia crónica de las extremidades inferiores
- San Norberto García, Enrique
- Brizuela, J. A.
- Merino Díaz, Borja
- Vaquero Puerta, Carlos
ISSN: 0304-5412
Année de publication: 2013
Titre de la publication: Enfermedades cardiovasculares (XI): enfermedades vasculares
Serie: 11
Número: 45
Pages: 2684-2690
Type: Article
D'autres publications dans: Medicine: Programa de Formación Médica Continuada Acreditado
Résumé
Chronic limb ischemia is growing in prevalence and its incidence increases with age and up to 20 % of people aged over 60. The incidence is also high in smokers, diabetes patients, and those with coronary disease. The most common initial symptom is intermittent claudication. More severe or critical limb ischaemia can present with pain at rest, ulceration, tissue loss and/or gangrene. This severe form is associated with high rates of limb loss, morbidity and mortality. A focused history should identify the presence and severity of intermittent claudication and any critical limb ischaemia. Examination should concentrate on the palpation of lower limb pulses and look for signs of critical ischaemia such as ulceration. The key primary care investigation in suspected peripheral arterial disease is measurement of the ankle brachial pressure index. Lifestyle interventions are a key component of management. Pharmacological treatment, open surgery and endovascular procedures are indicated in selected patients.
Références bibliographiques
- L. Norgren, W.R. Hiatt, J.A. Dormandy, M.R. Nehler, K.A. Harris, F.G. Fowkes, TASC II Working Group Inter-Society Consensus for the management of peripheral arterial disease (TASC II) J Vasc Surg, 45 (2007), pp. S5-S67
- J. Mehlsen, N. Wiinberg, B.S. Josegensen, P. Shultz Larsen High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event Blood Press, 19 (2010), pp. 308-312
- C. Bullen Impact of tobaco smoking and smoking cessarion on cardiovascular risk and disease Expert Rev Cardiovasc Ther, 6 (2008), pp. 883-895
- S. Aggarwal, R.S. Loomba, R. Arora preventive aspects in peripheral artery disease Ther Adv Cardiovasc Dis, 6 (2012), pp. 53-70
- A. Simmons, K. Steffen, S. Sanders Medical therapy for peripheral arterial disease Curr Opin Cardiol, 27 (2012), pp. 592-597
- C.C. Wang, J.E. Reusch Diabetes and cardiovascular disease: changing the focus from glycemic control to improving long term survival Am J Cardiol, 110 (2012), pp. 58B-68B
- F. Cacciapuoti Hyper homocysteinemia: a novel risk factor or a powerful marker for cardiovascular diseases?. Pathogenetic and therapeutical uncertainties J Thromb Thrombolysis, 32 (2011), pp. 82-88
- G. Peach, M. Griffin, K.G. Jones, M.M. Thompson, R.J. Hinchlife Diagnosis and management of peripheral arterial disease BMJ, 14 (2012), p. e5208
- J.W. Olin, D.E. Allie, M. Belkin, R.O. Bonow, D.E. Casey Jr., M.A. Creager ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 20120 performance measures for adults with peripheral artery disease Vasc Med, 15 (2010), pp. 481-512
- N. Diehm, A. Silvestro, I. Baumgartner, D.D. Do, C. Diehm, J. Schmidli, Chronic critical limb ischemia: European experiences J Cardiovasc Surg (Torino), 50 (2009), pp. 647-653
- A.T. Hirsch, Z.J. Haskal, N.R. Hertzer, C.W. Bakal, M.A. Creager, J.L. Halperin, ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) Circulation, 113 (2006), pp. e463-e465
- M.S. Conte Critical appraisal of surgical revascularization for critical limb ischemia J Vasc Surg, 57 (2013), pp. 8S-13S
- M. Tendera, V. Aboyans, M.L. Bartelink, I. Baumgartner, D. Clément, J.P. Collet ESC guidelines on the diagnosis and treatment of peripheral artery disease European Heart Journal, 32 (2011), pp. 2851-2906
- M. Cournot, H. Boccalon, J. Cambou, J. Guilloux, D. Taraszkiewicz, H. Hanaire Broutin, Accuracy of the screening physical examination to identify subclinical atheresclerosis and peripheral arterial disease in asymptomatic subjects J Vasc Surg, 46 (2007), pp. 1215-1221
- J.D. Hooi, H.E. Stoffers, A.D. Kester, J.A. Knottnerus Peripheral arterial occlusive disease: prognosis value of signs, symptoms, and the ankle-brachial pressure index Med Decis Making, 22 (2002), pp. 99-107
- C. Espinola Klein, H.J. Rupprecht, C. Bickel, K. Lackner, S. Savvidis, C.M. Messow, Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction Circulation, 118 (2008), pp. 961-967
- M. Bundó, L. Muñoz, C. Pérez, J. Montero, N. Montero, P. Toran, Asymptomatic peripheral arterial disease in type 2 diabetes patients: a 10 year follow-up study of the utility of the ankle brachial index as a prognostic marker of cardiovascular disease Ann Vasc Surg, 24 (2010), pp. 985-993
- D. Clair, S. Shah, J. Weber Current state of diagnosis and management of critical limb ischemia Curr Cardiol Rep, 14 (2012), pp. 160-170
- N.M. Hamburg, G.J. Balady Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits Circulation, 123 (2011), pp. 87-97
- F.N. Ali, T.L. Carman Medical management for chronic atherosclerotic peripheral arterial disease Drugs, 12 (2012), pp. 2073-2085
- P.L. Antignani Treatment of chronic peripheral arterial disease Curr Vasc Pharmacol, 1 (2003), pp. 205-216
- F. Fowkes, G.C. Leng Bypass surgery for chronic lower limb ischaemia Cochrane Database Syst Rev, 16 (2008), p. CD002000
- J. Van den Berg, S. Waser, S. Trelle, N. Diehm, I. Baumgartner Lesion characteristics of patients with chronic critical limb ischemia that determine choice of treatment modality J Cardiovasc Surg (Torino), 53 (2012), pp. 45-52
- J.H. Rogers, J.R. Laird Overview of new technologies for lower extremity revascularization Circulation, 30 (2007), pp. 2072-2085
- K.M. Balzer, B.T. Weis Müller Results of open vascular surgical therapy in chronic peripheral arterial disease Vasa, 40 (2011), pp. 359-367
- S. Venkatachlam, M.H. Shishehbor, B.H. Gray Basic data related to endovascular management of peripheral arterial disease in critical limb ischemia Ann Vasc Surg, 26 (2012), pp. 1039-1051
- F. Fowkes, G.C. Leng Bypass surgery for chronic lower limb ischaemia Cochrane Database Syst Rev, 16 (2008), p. CD002000
- A. Nanjundappa, A. Jain, K. Cohoon, R.S. Dieter Percutaneous management of chronic critical limb ischemia Cardiol Clin, 29 (2011), pp. 395-410
- B.E. Muhs, P.J. Gagne, T. Maldonado, P. Sheehan Minimally invasive revascularization strategies for chronic lower limb ischemia Int J Low Extrem Wounds, 5 (2006), pp. 35-39
- P.B. Dattilo, I.P. Casserly Critical limb ischemia: endovascular strategies for limb salvage Prog Cardiovasc Dis, 54 (2011), pp. 47-60
- D.P. Slovut, T.M. Sullivan Critical limb ischemia: medical and surgical management Vasc Med, 13 (2008), pp. 281-291