下肢动脉硬化闭塞症研究进展： 流行病学负担、综合管理策略 与患者预后
Research Progress on Lower Extremity Arteriosclerosis Obliterans: Epidemiological Burden, Management Strategies, and Patient Outcomes
摘要: 下肢动脉硬化闭塞症(Lower Extremity Arteriosclerosis Obliterans, ASO)是全身性动脉粥样硬化在下肢动脉的局部表现，其疾病谱涵盖从无症状、间歇性跛行(Intermittent Claudication, IC)直至慢性肢体威胁性缺血(Chronic Limb-Threatening Ischemia, CLTI)的完整过程。CLTI作为ASO的终末阶段，以静息痛、组织缺损(溃疡或坏疽)为特征，与高截肢率、高死亡率及沉重的社会经济负担密切相关。进入21世纪以来，随着全球人口老龄化及糖尿病、慢性肾脏病等合并症患病率的攀升，ASO的疾病负担持续加重。与此同时，血管内治疗技术的革新、新型药物疗法的应用、国际指南的迭代更新以及对疾病多维评估的深化，共同推动着ASO管理理念与实践模式的快速演进。本综述严格依据近期发表的关键文献，旨在系统阐述ASO/CLTI的全球与地区流行病学现状、疾病定义与评估体系的进展、基于最新指南的综合管理策略核心要点、影响患者预后的关键因素，并梳理当前研究面临的挑战与未来方向，以期为临床实践与科学研究提供基于证据的全面视角。
Abstract: Lower Extremity Arteriosclerosis Obliterans (ASO) represents the local manifestation of systemic atherosclerosis within the arteries of the lower limbs. Its disease spectrum encompasses a full continuum ranging from asymptomatic disease and intermittent claudication (IC) to chronic limb-threatening ischemia (CLTI). As the terminal stage of ASO, CLTI is characterized by rest pain and tissue loss (ulceration or gangrene), and is closely associated with high amputation rates, elevated mortality, and a substantial socioeconomic burden. Since the beginning of the 21st century, the global burden of ASO has intensified, driven by population aging and rising prevalence of comorbidities such as diabetes mellitus and chronic kidney disease. Concurrently, advancements in endovascular techniques, the application of novel pharmacological therapies, iterative updates to international guidelines, and a deeper understanding of multidimensional disease assessment have collectively propelled rapid evolution in the management concepts and practice patterns for ASO. Drawing strictly upon recently published key literature, this review aims to systematically delineate the current global and regional epidemiological landscape of ASO/CLTI, progress in disease definitions and assessment frameworks, core principles of comprehensive management strategies based on the latest guidelines, and key factors influencing patient prognosis. Furthermore, it outlines current research challenges and future directions, with the goal of providing an evidence-based, comprehensive perspective to inform clinical practice and scientific investigation.
文章引用：张伟, 李凤贺. 下肢动脉硬化闭塞症研究进展： 流行病学负担、综合管理策略 与患者预后[J]. 临床医学进展, 2026, 16(6): 189-196. https://doi.org/10.12677/acm.2026.1662209

参考文献

[1] Yong, J., Wang, Y., Xing, S., Bi, Y., Li, N. and Zhao, S. (2019) Efficacy of Trimetazidine and Plasmin Combined with Alprostadil in Treatment of Lower Extremity Arteriosclerosis Obliterans. Experimental and Therapeutic Medicine, 17, 4554-4560. [Google Scholar] [CrossRef] [PubMed]
[2] Huang, S., Chen, Z., Wu, W., Wang, M., Wang, R., Cui, J., et al. (2018) MicroRNA-31 Promotes Arterial Smooth Muscle Cell Proliferation and Migration by Targeting Mitofusin-2 in Arteriosclerosis Obliterans of the Lower Extremitie. Experimental and Therapeutic Medicine, 15, 633-640. [Google Scholar] [CrossRef] [PubMed]
[3] Song, P., Rudan, D., Zhu, Y., Fowkes, F.J.I., Rahimi, K., Fowkes, F.G.R., et al. (2019) Global, Regional, and National Prevalence and Risk Factors for Peripheral Artery Disease in 2015: An Updated Systematic Review and Analysis. The Lancet Global Health, 7, e1020-e1030. [Google Scholar] [CrossRef] [PubMed]
[4] Yan, C., Chen, J., Xu, X., Wei, H. and Li, J. (2025) Global Burden of Peripheral Arterial Disease (1990-2021), Global Burden Trends and the Impact of Blood Lead on Peripheral Arterial Disease: A Multidimensional Analysis Based on NHANES, GBD, and Mendelian Randomization. Journal of Translational Medicine, 23, Article No. 463. [Google Scholar] [CrossRef] [PubMed]
[5] Gong, W., Shen, S. and Shi, X. (2022) Secular Trends in the Epidemiologic Patterns of Peripheral Artery Disease and Risk Factors in China from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. Frontiers in Cardiovascular Medicine, 9, Article ID: 973592. [Google Scholar] [CrossRef] [PubMed]
[6] Søgaard, M., Behrendt, C., Eldrup, N. and Skjøth, F. (2025) Lifetime Risk of Lower Extremity Peripheral Arterial Disease: A Danish Nationwide Longitudinal Study. European Heart Journal, 46, 1206-1215. [Google Scholar] [CrossRef] [PubMed]
[7] Anantha-Narayanan, M., Doshi, R.P., Patel, K., Sheikh, A.B., Llanos-Chea, F., Abbott, J.D., et al. (2021) Contemporary Trends in Hospital Admissions and Outcomes in Patients with Critical Limb Ischemia: An Analysis from the National Inpatient Sample Database. Circulation: Cardiovascular Quality and Outcomes, 14, e007539. [Google Scholar] [CrossRef] [PubMed]
[8] Mentias, A., Qazi, A., McCoy, K., Wallace, R., Vaughan-Sarrazin, M. and Girotra, S. (2020) Trends in Hospitalization, Management, and Clinical Outcomes among Veterans with Critical Limb Ischemia. Circulation: Cardiovascular Interventions, 13, e008597. [Google Scholar] [CrossRef] [PubMed]
[9] Hong, M.S., Beck, A.W. and Nelson, P.R. (2011) Emerging National Trends in the Management and Outcomes of Lower Extremity Peripheral Arterial Disease. Annals of Vascular Surgery, 25, 44-54. [Google Scholar] [CrossRef] [PubMed]
[10] Zhu, B., Cui, R., Liu, H., Tuo, S. and Li, Y. (2026) A Randomized Controlled Trial of Drug-Coated Balloon versus Conventional Balloon Angioplasty in Diabetic Patients with Lower Extremity Arteriosclerosis Obliterans: Outcomes in Ankle-Brachial Index and Restenosis Rate. Diabetology & Metabolic Syndrome, 18, Article No. 92. [Google Scholar] [CrossRef] 
[11] Cai, Z., Guo, L., Qi, L., Cui, S., Tong, Z., Guo, J., et al. (2020) Midterm Outcome of Directional Atherectomy Combined with Drug-Coated Balloon Angioplasty versus Drug-Coated Balloon Angioplasty Alone for Femoropopliteal Arteriosclerosis Obliterans. Annals of Vascular Surgery, 64, 181-187. [Google Scholar] [CrossRef] [PubMed]
[12] Yang, Y., Ge, F., Shen, J., Song, J., Xie, J., Qu, J., et al. (2020) The Relationship between Neutrophil-Lymphocyte Ratio and In-Stent Restenosis in Superficial Femoral Artery. Bioscience Reports, 40, BSR20193448. [Google Scholar] [CrossRef] [PubMed]
[13] Azuma, N. (2018) The Diagnostic Classification of Critical Limb Ischemia. Annals of Vascular Diseases, 11, 449-457. [Google Scholar] [CrossRef] [PubMed]
[14] Abu Dabrh, A.M., Steffen, M.W., Undavalli, C., Asi, N., Wang, Z., Elamin, M.B., et al. (2015) The Natural History of Untreated Severe or Critical Limb Ischemia. Journal of Vascular Surgery, 62, 1642-1651.e3. [Google Scholar] [CrossRef] [PubMed]
[15] Kim, S.H. and Lee, S.S. (2025) Endovascular Recanalization for Infrapopliteal Artery Disease in Chronic Limb-Threatening Ischemia: A Practical Review. Vascular Specialist International, 41, Article No. 39. [Google Scholar] [CrossRef] 
[16] Cheun, T.J., Hart, J.P. and Davies, M.G. (2025) The Value of Restaging Wifi (Wound, Ischemia, and Foot Infection) after Initial Vascular and Podiatric Intervention. Annals of Vascular Surgery, 111, 319-330. [Google Scholar] [CrossRef] [PubMed]
[17] Conte, M.S., Bradbury, A.W., Kolh, P., et al. (2019) Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. European Journal of Vascular and Endovascular Surgery, 58, S1-S109.
[18] Chen, Z., Tan, T., Zhao, Y., Jiang, C., Zeng, Q., Fan, G., et al. (2023) Wifi Classification Based Analysis of Risk Factors for Outcomes in Patients with Chronic Limb Threatening Ischaemia after Endovascular Revascularisation Therapy. European Journal of Vascular and Endovascular Surgery, 65, 528-536. [Google Scholar] [CrossRef] [PubMed]
[19] Nomura, T., Shoji, K., Kitamura, M., Yoshida, S., Ono, K., Wada, N., et al. (2026) Impact of Controlling Nutritional Status Score on Comprehensive Clinical Outcomes in Patients with Chronic Limb-Threatening Ischemia in a Local Area of Super-Aged Society. Journal of Endovascular Therapy, 33, 430-438. [Google Scholar] [CrossRef] [PubMed]
[20] O'Banion, L.A., Saadi, S., Hasan, B., Nayfeh, T., Simons, J.P., Murad, M.H., et al. (2023) Lack of Patient-Centered Evaluation of Outcomes in Intermittent Claudication Literature. Journal of Vascular Surgery, 78, 828-836. [Google Scholar] [CrossRef] [PubMed]
[21] Debus, E.S., Kriston, L., Schwaneberg, T., Hischke, S., Rieß, H.C., Härter, M., et al. (2018) Rationale and Methods of the IDOMENEO Health Outcomes of the Peripheral Arterial Disease Revascularisation Study in the Germanvasc Registry. Vasa, 47, 499-505. [Google Scholar] [CrossRef] [PubMed]
[22] Mazzolai, L., Teixido-Tura, G., Lanzi, S., Boc, V., Bossone, E., Brodmann, M., et al. (2024) 2024 ESC Guidelines for the Management of Peripheral Arterial and Aortic Diseases. European Heart Journal, 45, 3538-3700. [Google Scholar] [CrossRef] [PubMed]
[23] Gornik, H.L., Aronow, H.D., Goodney, P.P., Arya, S., Brewster, L.P., Byrd, L., et al. (2024) 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 149, e1313-e1410. [Google Scholar] [CrossRef] [PubMed]
[24] Bonaca, M.P., Hamburg, N.M. and Creager, M.A. (2021) Contemporary Medical Management of Peripheral Artery Disease. Circulation Research, 128, 1868-1884. [Google Scholar] [CrossRef] [PubMed]
[25] Nash, D., McClure, G., Mastracci, T.M. and Anand, S.S. (2022) Social Deprivation and Peripheral Artery Disease. Canadian Journal of Cardiology, 38, 612-622. [Google Scholar] [CrossRef] [PubMed]
[26] Katsanos, K., Spiliopoulos, S., Saha, P., Diamantopoulos, A., Karunanithy, N., Krokidis, M., et al. (2015) Comparative Efficacy and Safety of Different Antiplatelet Agents for Prevention of Major Cardiovascular Events and Leg Amputations in Patients with Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis. PLOS ONE, 10, e0135692. [Google Scholar] [CrossRef] [PubMed]
[27] Giles, K.A., Farber, A., Menard, M.T., Conte, M.S., Nolan, B.W., Siracuse, J.J., et al. (2024) Surgery or Endovascular Therapy for Patients with Chronic Limb-Threatening Ischemia Requiring Infrapopliteal Interventions. Journal of Vascular Surgery, 80, 1515-1524. [Google Scholar] [CrossRef] [PubMed]
[28] Lovelock, T., Randhawa, S., Wells, C., Dean, A. and Khashram, M. (2024) Contemporary Outcomes of Infrainguinal Vein Bypass Surgery for Chronic Limb-Threatening Ischaemia: A Two-Centre Cross-Sectional Study. Journal of Clinical Medicine, 13, Article No. 5343. [Google Scholar] [CrossRef] [PubMed]
[29] Dua, A., Powell, R.J., Lee, A.C., Bernardo, N., Mills, J.L., Cardona, L.F., et al. (2025) Contemporary Outcomes in No-Option Chronic Limb-Threatening Ischemia. Scientific Reports, 15, Article No. 24446. [Google Scholar] [CrossRef] [PubMed]
[30] Kwiatkowski, T., Zbierska-Rubinkiewicz, K., Krzywoń, J., Szkółka, Ł., Kuczmik, W., Majka, M., et al. (2022) Cellular Therapies in No-Option Critical Limb Ischemia: Present Status and Future Directions. Advances in Interventional Cardiology, 18, 340-349. [Google Scholar] [CrossRef] [PubMed]
[31] Aboul-Ella, H., Gohar, A., Ali, A.A., Ismail, L.M., Mahmoud, A.E.E., Elkhatib, W.F., et al. (2024) Monoclonal Antibodies: From Magic Bullet to Precision Weapon. Molecular Biomedicine, 5, Article No. 47. [Google Scholar] [CrossRef] [PubMed]
[32] Liu, W., Balu, N., Canton, G., Hippe, D.S., Watase, H., Waterton, J.C., et al. (2019) Understanding Atherosclerosis through an Osteoarthritis Data Set. Arteriosclerosis, Thrombosis, and Vascular Biology, 39, 1018-1025. [Google Scholar] [CrossRef] [PubMed]
[33] Fabiani, I., Calogero, E., Pugliese, N.R., Di Stefano, R., Nicastro, I., Buttitta, F., et al. (2018) Critical Limb Ischemia: A Practical Up-to-Date Review. Angiology, 69, 465-474. [Google Scholar] [CrossRef] [PubMed]
[34] Ziegler, L., Hedin, U. and Gottsäter, A. (2022) Circulating Biomarkers in Lower Extremity Artery Disease. European Cardiology Review, 17, e09. [Google Scholar] [CrossRef] [PubMed]
[35] Fioretti, V., Gerardi, D., Giugliano, G., Di Fazio, A. and Stabile, E. (2023) Focus on Prevention: Peripheral Arterial Disease and the Central Role of the Cardiologist. Journal of Clinical Medicine, 12, Article No. 4338. [Google Scholar] [CrossRef] [PubMed]
[36] Aboyans, V., Canonico, M.E., Chastaingt, L., Anand, S.S., Brodmann, M., Couffinhal, T., et al. (2025) Peripheral Artery Disease. Nature Reviews Disease Primers, 11, Article No. 68. [Google Scholar] [CrossRef] 

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