Gå direkt till huvudinnehållet

Benartärsjukdom, claudicatio

Senast uppdaterad: Senast reviderad:


Definition:
Perifer benartärsjukdom till följd av ateroskleros, innefattande asymtomatisk benartärsjukdom, claudicatio intermittens, kronisk kritisk extremitetsischemi och akut ischemi.
Förekomst:
Cirka en femtedel av personer 60–90 år har benartärsjukdom.
Symtom:
Varierar från inga symtom till vilosmärtor med vävnadsdöd. 
Kliniska fynd:
Kan bestå av nedsatta perifera pulsar, ankel-/armtrycksindex ≤0,9, hudförändringar (sår) och stenosljud.
Diagnostik:
Baseras i första hand på ankel-/armtrycksindex ≤0,9 och ibland gångtest. Duplexundersökning (ultraljud) och tåtrycksmätning i vissa fall.
Behandling:
Består av anpassning av ohälsosamma levnadsvanor (särskilt rökstopp), gångträning/fysisk aktivitet och statinbehandling. Trombocythämmande läkemedel hos symtomatiska patienter. Kirurgi kan bli aktuellt.
  1. Aboyans V, Ricco JB, Bartelink MEL, et al; ESC Scientific Document Group. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO), the Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. Epub 26 aug 2017. PMID:28886620. PubMed  
  2. Sveriges regioner i samverkan. Personcentrerat och sammanhållet vårdförlopp Kritisk benischemi. Godkänt 2020-09-25 (Hämtad 2020-11-24). nationelltklinisktkunskapsstod.se  
  3. Fowkes FG, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 382; 9901: 1329-40. pmid:23915883 PubMed  
  4. Sigvant B, Wiberg-Hedman K, Bergqvist D, et al. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg. 2007;45:1185-1191 PubMed  
  5. Belch JJ, Topol EJ, Agnelli G, et al, Prevention of Atherothrombotic Disease Network. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med 2003; 163: 884-92. PubMed  
  6. Koutakis P, Johanning JM, Haynatzki GR, et al. Abnormal joint powers before and after the onset of claudication symptoms. J Vasc Surg 2010; 52: 340-7. PubMed  
  7. Joosten MM, Pai JK, Bertoia ML, et al. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA 2012; 308: 1660-7. Journal of the American Medical Association  
  8. Regensteiner JG, Hiatt WR. Current medical therapies for patients with peripheral arterial disease: a critical review. Am J Med 2002;112:49-57. PubMed  
  9. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Resp 2015; 116(9): 1509-26. pmid:25908725 PubMed  
  10. Koraen L, Wahlberg E. ABC om Claudicatio intermittens. Läkartidningen 2010; 29-31: 1774-1779. www.lakartidningen.se  
  11. Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease?. JAMA 2006; 295: 536-46. PubMed  
  12. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS) published online ahead of print, 2020 Aug 29. Eur Heart J. 2020;ehaa612. PMID:32860505. PubMed  
  13. Management of peripheral arterial disease: Transatlantic Intersociety Consensus (TASC). Eur J Vasc Endovasc Surg 2000; 19(suppl A): S1-S244.
  14. Sacks D, Bakal CW, Beatty PT, et al. Position statement on the use of the ankle-brachial index in the evaluation of patients with peripheral vascular disease: a consensus statement developed by the standards division of the Society of Cardiovascular & Interventional Radiology. J Vasc Interv Radiol 2002; 13: 353. PubMed  
  15. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: 726-79. pmid:27851992 PubMed  
  16. Wickström JE, Laivuori M, Aro E, et al. Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease. Eur J Vasc Endovasc Surgery 2017; 53(5): 696-703. pmid:28292565 PubMed  
  17. Menke J, Larsen J. Meta-analysis: Accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-. Ann Intern Med 2010; 153: 325-34. Annals of Internal Medicine  
  18. Met R, Bipat S, Legemate DA, Reckers JA, Koelemay MJW. Diagnostic performance of computed tomography angiography in peripheral arterial disease. A systematic review and meta-analysis. JAMA 2009; 301: 415-24. Journal of the American Medical Association  
  19. Ouwendijk R, de Vries M, Pattynama PM, et al. Imaging peripheral arterial disease: a randomized controlled trial comparing contrast-enhanced MR angiography and multi-detector row CT angiography. Radiology 2005; 236: 1094-103. Radiology  
  20. Nationellt kliniskt kunskapsstöd. Perifer arteriell sjukdom. 2021-04-14 (hämtad 2022-03-17). nationelltklinisktkunskapsstod.se  
  21. Stewart KJ, Hiatt WR, Regensteiner JG, Hirsch AT. Exercise training for claudication. N Engl J Med 2002;347:1941-51. New England Journal of Medicine  
  22. McDermott MM, Spring B, Tian L, et al. Effect of Low-Intensity vs High-Intensity Home-Based Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease The LITE Randomized Clinical Trial. JAMA 2021; 325: 1266-76. pmid:33821898 PubMed  
  23. Lane R, Ellis B, Watson L, et al. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2014 Jul 18;7:CD000990. DOI: 10.1002/14651858.CD000990.pub3. DOI  
  24. Parmenter BJ, Dieberg G, Phipps G et al. Exercise training for health-related quality of life in peripheral artery disease: a systematic review and meta-analysis. Vasc Med. 2015;20(1):30-40. PubMed  
  25. Lyu X, Li S, Peng S, et al. Intensive walking exercise for lower extremity peripheral arterial disease: A systematic review and meta-analysis.J Diabetes. 2016 May;8(3):363-77. Epub 2015 Jul 21. PMID: 25940390. PubMed  
  26. Leng GC, Fowler B, Ernst E. Exercise for intermittent claudication (Cochrane Review). The Cochrane Library, 2000, issue 2. The Cochrane Library  
  27. Bendermacher BL, Willigendael EM, Teijink JA, Prins MH. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev 2006; 2: CD005263. Cochrane (DOI)  
  28. Parmenter BJ, Dieberg G, Smart NA. Exercise training for management of peripheral arterial disease: a systematic review and meta-analysis. Sports Med. 2015 Feb;45(2):231-44. doi: 10.1007/s40279-014-0261-z. DOI  
  29. Saxton JM, Zwierska I, Blagojevic M, et al. Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease. J Vasc Surg 2011; 53: 1265-73. PubMed  
  30. Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4. The Cochrane Library  
  31. Hankey GJ, Norman PE, Eikelboom JW. Medical treatment of peripheral arterial disease. JAMA 2006; 295: 547-53. PubMed  
  32. Paravastu SC, Mendonca DA, Da Silva A. Beta blockers for peripheral arterial disease. Cochrane Database Syst Rev. 2013 Sep 11;9:CD005508. Cochrane (DOI)  
  33. Katsanos K, Spiliopoulos S, Saha P, et al. 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. 2015 Aug 14;10(8):e0135692.
  34. Berger JS, Krantz MJ, Kittelson JM, Hiatt WR. Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease. A meta-analysis of randomized trials. JAMA 2009; 301: 1909-19. Journal of the American Medical Association  
  35. Fowkes FG, Price JF, Stewart MC, et al. Aspirin for prevention of cardiovascular events in a generela population screende for a low ankle brachial index: a randomized controlled trial. JAMA 2010; 303: 841-8. Journal of the American Medical Association  
  36. Cosmi B, Conti E, Coccheri S. Anticoagulants (heparin, low molecular weight heparin and oral anticoagulants) for intermittent claudication. Cochrane Database Syst Rev. 2014 May 7;5:CD001999. Cochrane (DOI)  
  37. Janusinfo (Region Stockholm). Rivaroxaban vid koronar­sjukdom och perifer artärsjukdom – COMPASS-studien. 2019-09-12 (Hämtad 2019-10-14). www.janusinfo.se  
  38. Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in Peripheral Artery Disease after Revascularization published online ahead of print, 2020 Mar 28. N Engl J Med. PMID:32222135. PubMed  
  39. Benartärsjukdom - diagnostik och behandling. SBU-rapport 2007. www.sbu.se  
  40. de Backer TLM, Vander Stichele R, Lehert P, Van Bortel L. Naftidrofuryl for intermittent claudication. Cochrane Database of Systematic Reviews 2008; 2: CD001368. Cochrane (DOI)  
  41. Stevens JW, Simpson E, Harnan S, et al. Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg 2012; 99: 1630-8. pmid:23034699 PubMed  
  42. Bedenis R, Stewart M, Cleanthis M, et al. Cilostazol for intermittent claudication. Cochrane Database Syst Rev 2014; 10: CD003748. doi:10.1002/14651858.CD003748.pub4. DOI  
  43. Abu Dabrh AM, Steffen MW, Asi N, et al. Bypass surgery versus endovascular interventions in severe or critical limb ischemia. J Vasc Surg. 2016 Jan;63(1):244-53.e11. pmid: 26372187 PubMed  
  44. Malgor RD, Alalahdab F, Elraiyah TA, et al. A systematic review of treatment of intermittent claudication in the lower extremities. Vasc Surg. 2015 Mar;61(3 Suppl):54S-73S. doi.
  45. Hess CN, Debus ES, Nehler MR, et al. Reduction in Acute Limb Ischemia With Rivaroxaban Versus Placebo in Peripheral Artery Disease After Lower Extremity Revascularization: Insights From VOYAGER PAD. Circulation 2021; 144: 1831-41. pmid:34637332 PubMed  
  46. Robertson L, Ghouri MA, Kovacs F. Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Database Syst Rev 2012; 8: CD002071. The Cochrane Library  
  47. Pedersen G, Laxdal E, Jonung T, Aune S. Claudicatio intermittens - diagnostikk og behandling. Tidsskr Nor Lægeforen 2007; 127: 167-70. PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Anders Gottsäter, docent och överläkare, Kärlkliniken, Skånes universitetssjukhus