循環器ジャーナル67巻2号

2019年04月発行

特集 心疾患治療としての心臓リハビリテーション Ⅲ．各種疾患の心臓リハビリテーション

末梢動脈疾患に対するリハビリテーションの適応と効果

著者： 安城直史¹ 安隆則¹

所属機関： ¹獨協医科大学日光医療センター心臓・血管・腎臓内科

ページ範囲：P.306 - P.312

Point
・重症虚血肢を除く末梢動脈疾患の初期治療第一選択は，運動療法と抗血小板薬である．
・重症虚血肢には，血行再建術後に予後改善のために運動療法を指導することが肝要である．
・跛行症状のある末梢動脈疾患において運動療法は監視下で導入することがガイドラインで推奨されているが，監視下での導入が困難であれば，非監視下での運動を可能な限り早期に開始すべきである．

参考文献

1) Watson L, Ellis B, Leng GC, et al:Exercise for intermittent claudication（Review）. Cochrane Database Syst Rev 8:CD000990, 2008

2) 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 382:1329-1340, 2013

3) Steg PG, Bhatt DL, Wilson PW, et al:One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 297:1197-1206, 2007

4) Alberts MJ, Bthatt DL, Mas JL, et al:Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry. Eur Heart J 30:2318-2326, 2009

5) Diehm C, Allenberg JR, Pittrow D, et al:Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation 120:2053-2061, 2009

6) US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, et al:Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index:US Preventive Services Task Force Recommendation Statement. JAMA 320:177-183, 2018

7) 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease:Executive Summary. Circulation 135:e686-e725, 2017

8) Alahdab F, Wang AT, Elraiyah TA, et al:A systematic review for the screening for peripheral artery disease in asymptomatic patients. J Vasc Surg 61:42S-53S, 2015

9) Norgren L, Hiatt WR, Dormandy JA, et al:Inter-Society Consensus for the Management of Peripheral Arterial Disease（TASCⅡ）. Eur J Vasc Endovasc Surg 33:S1-S75, 2007

10) 循環器病の診断と治療に関するガイドライン（2014年度合同研究班報告）．末梢閉塞性動脈疾患の治療ガイドライン（2015改訂版）．Circ J, 2016

11) Tendera M, Aboyans V, Bartelink ML, et al:ESC Guidelines on the diagnosis and treatment of peripheral artery diseases:Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries:the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology（ESC）. Eur Heart J 32:2851-2906, 2011

12) 安　隆則：末梢動脈疾患の心血管リハビリテーション．日本下肢救済・足病学会誌4:113-116, 2012

13) Gardner AW, Poehlman ET:Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA 274:975-980, 1995

14) Fokkenrood HJ, Bendermacher BL, Lauret GJ, et al:Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication（Review）. Cochrane Database Syst Rev 23:CD005263, 2013

15) Murphy TP, Cutlip DE, Regensteiner JG, et al:Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease:six-month outcomes from the claudication:exercise versus endoluminal revascularization（CLEVER）study. Circulation 125:130-139, 2012

16) Mohler ER, Hiatt WR, Creager MA:Cholesterol reduction with atorvastatin improves walking distance in patients with peripheral arterial disease. Circulation 108:1481-1486, 2003

17) Ishikawa Y, Yokoyama M, Saito Y, et al:Preventive effects of eicosapentaenoic acid on coronary artery disease in patients with peripheral artery disease. Circ J 74:1451-1457, 2010

cell number in patients with peripheral artery disease. Heart Vessels 32:1186-1194, 2017

19) Maejima Y, Yasu T, Ueba H, et al:Exercise after heparin administration:new therapeutic program for patients with non-option arteriosclerosis obliterans. Cir J 69:1099-1104, 2005

20) Otsuka S, Morisawa T, Yuguchi S, et al:Clinical importance of change in physical activity after endovascular treatment combined with exercise training in patients with peripheral arterial disease. Heart Vessels 32:143-148, 2017