Современные рекомендации по диагностике и лечению заболеваний артерий нижних конечностей в практике семейного врача (обзор литературы)

О. Б. Волошина

Аннотация


Целью этого обзора является анализ современных мировых достижений в диагностике и лечении заболеваний артерий нижних конечностей (ЗАНК) в клинической практике. На основании анализа данных литературы проведен обзор плацебо контролируемых  рандомизированных клинических исследований, результаты которых вошли в современные Европейские и Американские рекомендации по диагностике и лечению ЗАНК. Учитывая то, что наличие ЗАНК существенно повышает риск сердечно сосудистых  осложнений, современные международные руководства рекомендуют именно семейным врачам первичного звена осуществлять  скрининг на наличие патологии нижних конечностей, измеряя лодыжечно плечевой индекс (уровень рекомендаций АІ). 

Результаты многих плацебо контролируемых рандомизированных клинических исследований свидетельствуют, что цилостазол гораздо эффективнее, чем пентоксифиллин и другие препараты уменьшает клинические проявления нарушений артериального кровообращения в нижних конечностях, увеличивает максимальную и безболевую дистанцию ходьбы, улучшает качество жизни у больных с  ЗАНК. На основании этого в последних рекомендациях 2016 года  эксперты АНА/АСС (Американской Ассоциации сердца/Американского Колледжа Кардиологов) среди всех препаратов для консервативного лечения ЗАНК включили только цилостазол для лечения патологии периферических артерий (уровень рекомендаций АІ).


Ключевые слова


заболевания артерий нижних конечностей; диагностика; лечение; цилостазол; семейная медицина

Полный текст:

PDF (Українська)

Литература


TASC II Working Group. Inter Society Consensus for the Management of Peripheral Arterial Disease (TASC II). / L. oNrgren, W.R. Hiatt, J.A. Dormandy [et al.] // J Vasc Surg 2007; 45 (1suppl):S5–S67.

ESC Committee for Practice Guidelines. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC) / M. Tendera, V. Aboyans, M.L. Bartelink [et al.] // Eur Heart J 2011;32:2851–2906.

Chronic critical limb ischemia: European experiences / N. Diehm, A. Silvestro, I. Baumgartner [et al.] // J Cardiovasc Surg 2009; 50:647–653.

Treatment of intermittent claudication with pentoxifylline and cilostazol /J.A.Tjon, L.E. Riemann E // Am J Health Syst Pharm. 2001 Mar 15; 58( 6):485 93; quiz 494–6.

Platelet activation markers, microparticles and soluble adhesion molecules are elevated in patients with arteriosclerosis obliterans: therapeutic effects by cilostazol and potentiation by dipyridamole / S. Nomura, N. Inami, T. Iwasaka, Y. Liu // Platelets. 2004 May; 15(3):167–72.

ACC/ AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) / Hirsch AT, Haskal ZJ, Hertzer NR [et al.] // Circulation 2006; 113: 463–654.

A populationbasedstudy of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences / B. Sigvant, K. Wiberg Hedman, D. Bergqvist [et al.] / J Vasc Surg 2007;45:1185–1191.

Peripheral arterial disease—epidemiological aspects / M.N. Criqui // Vasc Med. 2001; 6:3–7.

Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease / P.M. Ridker, M.J. Stampfer, N. Rifai // JAMA. 2001; 285:2481–2485.

The prevalence of asymptomatic and unrecognized peripheral arterial occlusive disease / H.E. Stoffers, P.E. Rinkens, A.D. Kester [et al.] // Int J Epidemiol. 1996; 25:282–290.

Peripheral arterial disease in the elderly: the. Rotterdam Study / W.T. Meijer, A.W. Hoes, D. Rutgers et al. // Arterioscler Thromb Vasc Biol. 1998;18:185-192.

European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invitedexperts) / I.Graham, D. Atar, K. Borch Johnsen // Eur Heart J. 2007;28:2375–2414.

Peripheral arterial disease—epidemiologicalaspects / M.N. Criqui // Vasc Med. 2001; 6:3–7.

A marked decline in the prevalence and incidence of intermittent claudication in Icelandic men1968–1986: a strong relationship to smoking and serum choles terol the Reykjavik Study / I.O. Ingolfsson, G. Sigurdsson, H. Sigvaldason [et al.] // J Clin Epidemiol.1994; 47:1237–1243.

Temporal trends in the incidence of intermittent claudication from 1950 to 1999 / J.M. Murabito, J.C. Evans, R.B. Sr D’Agostino [et al.] // Am J Epidemiol. 2005; 162:430–437.

Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study / M.L. Bots, P.J. Breslau, E. Briet [et al.] // Hypertension. 1992; 19:717–720.

Mathiesen E.B. Prevalence of and risk factors associated with carotid artery stenosis: the Tromso Study / E.B. Mathiesen, O. Joakimsen, K.N. Bonaa // Cerebrovasc. Dis. 2001;12:44–51.

Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group / D.H. O’Leary, J.F. Polak, R.A. Kronmal [et al.] // Stroke. 1992; 23:1752–1760.

Настанова та клінічний протокол надання медичної допомоги «Артеріальна гіпертензія», затверджений Наказом МОЗ No384 від 24.05.2012. – К., 2012.– 108 с.

Prevalence of renovascular disease in the elderly: apopulation basedstudy / K.J. Hansen, M.S. Edwards, T.E. Craven [et al.] // J Vasc Surg. 2002; 36:443–451.

Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines / J.L. Anderson, J.L. Halperin, N.M. Albert [et al.] // J Am Coll Cardiol. 2013; 6:1555 – 1570.

Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence / H.Reinecke, M. Unrath, E. Freisinger [et al.] // Eur Heart J. 2015; 36: 932–938.

Chronic critical limb ischemia: European experiences / N. Diehm, A. Silvestro, I. Baumgartner [et al.] // J Cardiovasc Surg. 2009; 50:647 – 653.

The ankle-brachialindex and incident cardiovascular events in the MESA (Multi EthnicStudy of Atherosclerosis) / M.H. Criqui, R.L. McClelland, M.M.McDermott [et al.] // J Am Coll Cardiol. 2010; 56:1506–1512.

Limitation of the resting ankle-brachialindex in symptomatic patients with peripheral arterial disease / R. Stein, I. Hriljac, J.L. Halperin [et al.] // Vasc Med. 2006;11:29–33.

The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects / V. Aboyans, E. Ho, J.O. Denenberg [et al.] // J Vasc Surg. 2008; 48:1197–1203.

A modified calculation of ankle-brachialpressure index is far more sensitive in the detection of peripheral arterial disease / F. Schroder, N. Diehm, S. Kareem [et al.] // J Vasc Surg. 2006; 44:531–536.

Further evolution of the ACC/AHA clinical practice guideline recommendation classification system: a report of the American College of Cardiology/ Halperin JL, Levine GN, Al Khatib SM, et al. /American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016;133:1426-1428.

AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and U.S. Department of Health and Human Services/ Arnett DK, Goodman RA, Halperin JL, et al./ Circulation. 2014;130:1662–1667.

Quality of the assessment of primary and secondary endpoints in claudication and critical leg ischemia trials / W.R. Hiatt, L. Cox, M. Greenwalt [et al.] // Vasc Med. 2005; 10:207–213.

Critical evaluation of stress testing in the diagnosis of peripheral vascular disease / K. Ouriel, A.E. McDonnell, C.E. Metz, C.R. Zarins // Surgery. 1982; 91:686 –693. JG

Exercise testing and exercise rehabilitation for patients with peripheral arterial disease: status in 1997 / A. Regensteiner, A. Gardner, W.R. Hiatt [et al.] // Vasc Med. 1997; 2:147–155.

Diagnosis of arterial disease of the lower extremities with duplex ultrasonography / M.J. Koelemay, D. den Hartog, M.N. Prins [et al.] // Br J Surg.1996; 83:404–409.

Peripheral arterial disease: gadolinium-enhancedMR angiography versus color-guidedduplexUS-ameta-analysis / K. Visser, M.G. Hunink // Radiology. 2000; 216:67–77.

A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease / R. Collins, G. Cranny, J. Burch [et al.] // Health Technol Assess.2007;11:iii–iv,xi–xiii,1–184.

Knowledge and attitudes regarding cardiovascular disease risk and prevention in patients with coronary or peripheral arterial disease / M.M. Mc Dermott, M.M. McDermott, A.L. Mandapat [et al.] //Arch Intern Med. 2003;163:2157–2162.

Lipid lowering for peripheral arterial disease of the lower limb / H.G. Maxwell, R.G. Jepson, J.F. Price, G.C. Leng // Cochrane Database Syst Rev. 2007;4:CD000123.

ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR) / A. L. Catapano, I. Graham, G. De Backer [et al.] // Eur. Heart J. — 2016. — Vol. 37 (38). — P. 2999–3058.

ESC/EAS Guidelines for the managemeint of dyslipidaemias / Z. Reiner, A. Catapano, G. De Backer [et al.] // Eur Heart J. 2011;32:1769–1818

Exercise for intermittent claudication / L. Watson, B. Ellis, G.C. Leng // Cochrane Database Syst Rev. 2008; 4:CD000990.

Influence of smoking on incidence and prevalence of peripheral arterial disease / E.M. Willigendael, J.A. Teijink, M/L. Bartelink [et al.] // J Vasc Surg. 2004;40:1158-65.

The contribution of tobacco use to high health care utilization and medical / S. Duval, K.H. Long, S.S. Roy [et al.] //J Am Coll Cardiol. 2015; 66:1566-74.

Heart Protection Study Collaborative Group. Randomized trial of the effects of cholesterol lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20,536 people with peripheral arterial disease and other high risk conditions // J Vasc Surg. 2007;45:645-54.

AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines/ M.D. Gerhard Herman D, H.L. Gornik L, C. Barrett C [et al.] // J.Am.Col. Cardiol. 2017 Mar 21; 69(11):1465-1508.

The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts): European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) / Joep Perk, Guy De Backer, Helmut Gohlke [et al.] // Eur Heart J. 2012;33:1635–1701.

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee // Lancet. 1996; 348: 1329–1339.

Patients with peripheral arterial disease in the CHARISMA trial / P.P. Cacoub, D.L. Bhatt, P.G. Steg PG [et al.] // Eur Heart J. 2009; 30:192 –201.

The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease / J. Belch, A. MacCuish, L. Campbell [et al.] // BMJ. 2008; 337 doi: https://doi.org/10.1136/bmj.a1840 (Published 16 October 2008)

Outcomes Among hypertensive patients with concomitant peripheral and coronary artery disease: findings from the INternational VErapamil SR/Trandolapril STudy / A.A. Bavry, R.D. Anderson, Y. Gong [et al.] // Hypertension. 2010; 55:48 53.

Effect of nebivolol vs. hydrochlorothiazide on the walking capacity in hypertensive patients with intermittent claudication / C. Diehm, D. Pittrow, H. Lawall // J Hypertens. 2011; 29:1448-56.

Beta blockers for peripheral arterial disease / S.C. Paravastu, D.A. Mendonca, A. Da Silva // Cochrane Database Syst Rev. 2013; CD005508.

в-Blockers in patients with intermittent claudication and arterial hypertension: results from the nebivolol or metoprolol in arterial occlusive disease trial / C. Espinola Klein, G. Weisser, A. Jagodzinski [et al.] // Hypertension. 2011; 58:148-54.

Characteristics and long term follow up of participants with peripheral arterial disease during ALLHAT / L.B. Piller, L.M. Simpson, S. Baraniuk [et al] // J Gen Intern Med. 2014; 29:1475-83.

Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: an analysis of findings from the VALUE trial / A. Zanchetti, S. Julius, S. Kjeldsen [et al.] // J Hypertens. 2006; 24:2163-8.

Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease / J. Ostergren, P. Sleight, G. Dagenais [et al] // Eur Heart J. 2004;25:17-24.

Epidemiology of peripheral artery disease /M.H. Criqui, V. Abouans // Circ Res. 2015; 116:1509-26. 188. Resnick HE, Lindsay RS, McDermott MM, et al. Relationship of high and low ankle brachial index to allcause and cardiovascular disease mortality: the Strong Heart Study /Criqui MH, Aboyans V. // Circulation. 2004; 109:733-9.

Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome / E.B. Jude, S.O. Oyibo, N. Chalmers [et al.] // Diabetes Care. 2001; 24:1433-7. 190. American Diabetes Association. Peripheral arterial disease in people with diabetes // Diabetes Care. 2003; 26:3333-41.

Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty / S. Singh, E.J. Armstrong, W. Sherif, [et al.] // Vasc Med. 2014;19:307-14.

Cilostazol for intermittent claudication / R. Bedenis, M. Stewart, M. Cleanthis [et al.] // Cochrane Database Syst Rev. 2014; CD003748.

A comparison of cilostazol and pentoxifylline for treating intermittent claudication / D.L. Dawson, B.S. Cutler, W.R. Hiatt // Am J Med. 2000;109:523–30.

Pentoxifylline for intermittent claudication / K. Salhiyyah, E. Senanayake, M. Abdel Hadi [et al.] // Cochrane Database Syst Rev. 2012; 1:CD005262.

Плестазол (Plestazol): Інструкція до медичного застосування; затверджено Наказом МОЗ України No67 від 23.01.2014 No UA/13438/01/01.

Effect of cilostazol on platelet aggregation and experimental thrombosis / H. Kimura, T. Tani, T. Kanbe, K. Watanabe //Arzneimittelforschung. 1985; 35:1144–9.

Activation of endothelial nitric oxidesynthase by cilostazol via a cAMP/protein kinase A- and phosphatidylinositol 3-kinase/Akt-dependent mechanism / Hashimoto A., Miyakoda G., Hirose Y., Mori T. // Atherosclerosis. 2006 Dec; 189(2):350-7.

Cilostazol reduces inflammatory burden and oxidative stress in hypertensive type 2 diabetes mellitus patients / N.K. Agrawal, R. Maiti, D. Dash, B.L. Pandey // Pharmacol Res. 2007 Aug; 56(2):118-23.

Cilostazol Stimulates Revascularisation in Response to Ischaemia via an eNOS-Dependent Mechanism /A. Hori, R. Shibata, K. Morisaki [et al.] // Eur.J. of Vascular and Endovascular Surg, 2012, v.43, Issue 1, P.62-65.

Cilostazol induces vasodilation through the activation of Ca2+ activated K+ channels in aortic smooth muscle / Hongliang Li a , Da Hye Hong a, Youn Kyoung Son [et al.] // J.Vascular Pharm. 2015, V.70, 15-20.

A new pharmacological treatment for intermittent claudication: results of a randomized, multicenter trial / H.G. Beebe, D.L. Dawson, B.S. Cutler //Arch Intern Med. 1999 Sep 27; 159(17):2041-50.

Effect of cilostazol on treadmill walking, community based walking ability, and health related quality of life in patients with intermittent claudication due to peripheral arterial disease: metaanalysis of six randomized controlled trials / J.G. Regensteiner, J.E. Ware Jr, W.J. McCar, [et al.] // J Am Geriatr Soc. 2002 Dec; 50(12):1939-46.

Treatment of intermittent claudication with pentoxifylline and cilostazo / J.A. Tjon, L.E. Riemann // Am J Health Syst Pharm. 2001 Mar 15; 58(6):485-93; quiz 494-6.

Cost effectiveness of cilostazol compared with naftidrofuryl and pentoxifylline in the treatment of intermittent claudication in the UK / J.F.Guest., A.M. Davie, J.P. Clegg // Curr Med Res Opin. 2005 Jun; 21(6):817-26.

Comparison of the inhibitory effects of cilostazol, acetylsalicylic acid and ticlopidine on platelet functions ex vivo. Randomized, double-blind cross-over study / Y. Ikeda, M. Kikuchi, H. Murakami [et al.] // Arzneimittelforschung. 1987 May; 37(5):563-06.

A randomised, multicentre, double-blind, placebo controlled trial to evaluate the efficacy and safety of cilostazol in patients with vasospastic angina / E.S. Shin, J.H. Lee, S.Y. Yoo [et al.] // Heart doi: 10,1136/heartjnl-2014-305986.

Meta analysis of randomized controlled trials on effect of cilostazol on restenosis rates and outcomes after percutaneous coronary intervention / S.N. Friedland, M.J. Eisenberg, A. Shimony // Am J Cardiol. 2012 May 15; 109(10):1397-404.

Cilostazol stroke prevention study: A placebo controlled double-blind trial for secondary prevention of cerebral infarction / F. Gotoh, H. Tohgi, S. Hirai [et al.] // Stroke Cerebrovasc Dis. 2000 Jul Aug;9(4):147-57. doi: 10.1053/jscd.2000.7216.

Thecardioprotective effect of a statin and cilostazol combination: relationship toAkt and endothelial nitricoxide synthase activation / S. Manickavasagam, Y. Ye, Y. Lin [et al.] // Cardiovasc Drugs Ther. 2007; 21:321e30.

Lee C. Effect of cilostazol prescribed in a pragmatic treatment program for intermittent claudication / C. Lee, P.R. Nelson // Vasc Endovascular Surg. 2014; 48:224-9.

Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of inter mittent claudication / J.W. Stevens, E. Simpson, S. Harnan [et al.] // Br J Surg. – 2012. – Vol.99, N12. – P.1630-1638.

Pratt C.M. Analysis of the cilostazol safety database / C.M. Pratt // Am J Cardiol. 2001; 87:28D–33D.

Hiatt WR. The US experience with cilostazol in treating intermittent claudication / W.R. Hiatt // Atheroscler Suppl. 2006; 6:21–31.

Practice based evidence: profiling the safety of cilostazol by text mining of clinical note/Leeper N.J., Bauer Mehren A., Iyer S.V et al // PLoS One. 2013 May 23; 8(5):e63499




Copyright (c) 2017 Семейная медицина

Creative Commons License
Эта работа лицензирована Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

ISSN 2412-8708 (Online), ISSN 2307-5112 (Print)

Flag Counter