老年人下肢动脉粥样硬化闭塞症管理中国专家共识

Chinese expert consensus on management of peripheral arterial disease in the elderly

摘要:

下肢动脉粥样硬化闭塞症［又称外周动脉疾病（PAD）］是一种由动脉粥样硬化累及下肢动脉而导致管腔狭窄或闭塞，进而引发下肢缺血、坏死为特征的慢性动脉闭塞性疾病。PAD不仅显著降低患者生活质量，且存在不可忽视的截肢及死亡风险，给患者和社会带来沉重的经济与健康负担，尤其在老年患者中。高龄已被多项研究证实是PAD患者发生截肢和死亡的关键危险因素。老年人PAD患病率随患者年龄增长显著上升，且老年人常合并冠心病、肾功能不全、肿瘤等多种疾病，其病理生理特点、治疗选择及预后评估均较年轻患者更为复杂。诊断上，因老年PAD患者症状易被合并症掩盖，需结合详细病史、体征及辅助检查。治疗上，老年PAD患者治疗依从性差、随访困难等问题也增加了临床管理的难度。目前，国内外尚缺乏专门针对老年人PAD的诊疗指南或共识。基于此，制定了《老年人下肢动脉粥样硬化闭塞症管理中国专家共识》。本共识结合国内外最新循证医学证据及临床经验，重点阐述了老年PAD患者的疾病特点、合并症管理、个体化治疗、长期随访等重点问题，旨在制定科学、实用的诊疗规范，为临床医师提供指导。

Abstract:

Lower extremity arteriosclerosis obliterans, also known as peripheral artery disease (PAD), is a chronic arterial occlusive disease characterized by atherosclerosis affecting the arteries of the lower extremities, leading to luminal stenosis or occlusion, and consequently resulting in ischemia and necrosis of the lower limbs. PAD not only significantly reduces patients' quality of life but also carries a non-negligible risk of amputation and mortality, imposing a heavy economic and health burden on both patients and society, especially among the elderly. Advanced age has been identified in multiple studies as a key risk factor for amputation and death in PAD patients. The prevalence of PAD in the elderly increases significantly with age, as they often have multiple coexisting conditions such as coronary artery disease, renal insufficiency, and tumors. Consequently, the pathophysiological characteristics, treatment options, and prognostic assessments are more complex compared to those of younger patients. Diagnostically, because comorbidities can often mask the symptoms of PAD in elderly patients, a comprehensive approach involving detailed medical history, physical examination, and auxiliary tests is required. In terms of treatment, the management of elderly patients with PAD is further complicated by issues such as poor adherence to therapy and difficulties in follow-up, which increase the challenges in clinical management. Currently, there is a lack of specific national or international guidelines or consensuses focused on the diagnosis and treatment of PAD in the elderly. To address this gap, the "Chinese expert consensus on the management of lower extremity atherosclerotic disease in the elderly" has been developed. This consensus integrates the latest evidence-based medical data and clinical experience, with a focus on key issues in elderly PAD patients, such as disease characteristics, comorbidity management, personalized treatment, and long-term follow-up. It aims to establish scientific and practical diagnostic and therapeutic standards to provide guidance for clinicians.