Американские рекомендации по периферическому атеросклерозу (выпустила Американская Коллегия Кардиологов и Американская Ассоциация Сердца в соавторстве с сосудистыми, эндоваскулярными хирургами и другими специалистами).
http://www.guidelines.gov/summary/summary.aspx?doc_id=8503&nbr=004740&string=%22blue+toe%22Более подробная версия:
http://www.acc.org/qualityandscience/clinical/guidelines/pad/PADpocket.pdfВот, некоторые интересные выдержки из этого документа (в первую очередь, касающиеся медикаментозного лечения):
Class I recommendation: Treatment with a hydroxymethyl glutaryl (HMG) coenzyme-A reductase inhibitor (statin) medication is indicated for all patients with PAD to achieve a target low-density lipoprotein (LDL) cholesterol level of less than 100 mg per dL. (Level of Evidence: B)
Class I recommendation: Beta-adrenergic blocking drugs are effective antihypertensive agents and are not contraindicated in patients with PAD. (Level of Evidence: A)
О тренировочной ходьбе:
Class I recommendation: Supervised exercise training should be performed for a minimum of 30 to 45 minutes, in sessions performed at least 3 times per week for a minimum of 12 weeks. (Level of Evidence: A)
Class IIb recommendation: The usefulness of unsupervised exercise programs is not well established as an effective initial treatment modality for patients with intermittent claudication. (Level of Evidence: B)
Class I recommendation: Cilostazol (100 mg orally 2 times per day) is indicated as an effective therapy to improve symptoms and increase walking distance in patients with lower extremity PAD and intermittent claudication (in the absence of heart failure). (Level of Evidence: A)
Class IIb recommendations:
Pentoxifylline (400 mg 3 times per day) may be considered as second-line alternative therapy to cilostazol to improve walking distance in patients with intermittent claudication. (Level of Evidence: A)
The clinical effectiveness of pentoxifylline as therapy for claudication is marginal and not well established. (Level of Evidence: C)
The effectiveness of ginkgo biloba to improve walking distance for patients with intermittent claudication is marginal and not well established. (Level of Evidence: B)
Class III recommendation:
Oral vasodilator prostaglandins such as beraprost and iloprost are not effective medications to improve walking distance in patients with intermittent claudication. (Level of Evidence: A) – вот это интересно.... Я не нашел больше ничего о простагландинах (в т.ч., внутривенных) в этих рекомендациях
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