Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3803_Библиотеки_им_академика_М_И_Перельмана

Peripheral arterial disease (PAD) is a prevalent condition with an estimated 200 mil­lion people affected worldwide. There are many different presentations for PAD which may go unrecognized by patients and providers. It is critical to recognize this condition in order to implement measures to reduce cardiovascular morbidity and mortality and to reduce its progression. In patients with claudication and reduced ankle brachial index (ABI) <0.85 or those with prior revascularization for ischemia, about 20% will undergo elective revascularization and 4% urgent revascularization at 2-year follow-up. Cardiovascular death, myocardial infarction, and stroke will occur in 11% of these patients during the same 2years [1, 2]. Faringa etal. reported in patients with an ABI <0.90 a 10-year mortality of 40%. The comorbid conditions that increased the risk of death were renal dysfunction, heart failure, ST segment changes, age >65years, hyperlipidemia, ABI <0.60, Q waves, diabetes, cerebrovas­cular disease, and pulmonary disease [3]. In the VOYAGER-PAD study, in patients who had lower extremity revascularization, the 3-year incidence of death from car­diovascular causes, ischemic stroke, acute limb ischemia, major amputation from vascular causes, or ischemic stroke was almost 20% despite aggressive revascular­ization and medical therapy [4]. An even higher-risk population would include patients with diabetic foot wounds and PAD.Kim et al. looked at this group and found that 38% of these patients underwent major amputation. Osteomyelitis, con­gestive heart failure, leukocytosis, and dementia considerably increased the risk for amputation in this patient population [5].