[mizin1]

Вот кое-что, тоже мой выбор, по недавним ESC Guidelines on the diagnosis and treatment of peripheral artery diseases (The European Society of Cardiology 2011).

Про сонные артерии.
Полгода назад американцы писали – рекомендация I класса:
- CAS is indicated as an alternative to CEA for symptomatic patients at average or low risk of complications associated with endovascular intervention when the diameter of the lumen of the internal carotid artery is reduced by more than 70% as documented by noninvasive imaging or more than 50% as documented by catheter angiography and the anticipated rate of periprocedural stroke or mortality is less than 6%. (Level of Evidence: B).

Вот как сейчас пишут в Европе:
- In symptomatic patients requiring carotid revascularization, CAS may be considered as an alternative to CEA in high-volume centres with documented death or stroke rate <6%. (Это уже рекомендация IIb класса).
- Опять стентирование только при высоком хирургическом риске (класс IIА).

Все почечные реваскуляризации рекомендации на IIb месте.

Про диагностику артерий н/к. Дословно:
4.5.2.6 Digital subtraction angiography
- For the aorta and peripheral arteries, retrograde transfemoral catheterization is usually used. Cross-over techniques allow the direct antegrade flow imaging from one side to the other. If the femoral access is not possible, transradial or transbrachial approaches and direct antegrade catheterization are needed. Considered as the gold standard for decades, DSA is now reserved for patients undergoing interventions, especially concomitant to endovascular procedures. Indeed, the non-invasive techniques provide satisfying imaging in almost all cases, with less radiation, and avoiding complications inherent to the arterial puncture, reported in ,1% of cases.

Диагностика локализации заболеваний артерий н/к:
- DUS and/or CTA and/or MRA are indicated to localize lesions and consider revascularization options (класс IА).

Реваскуляризации н/к:
- When revascularization is indicated, an endovascular-first strategy is recommended in all aortoiliac and femoropopliteal TASC A–C lesions (класс IС). А это, например, двусторонние окклюзии общих подвздошных артерий, односторонняя окклюзия НПА с выраженным кальцинозом и распространением на общую бедренную артерию, окклюзии ПБА до 20см.
- Primary stent implantation should be considered in femoropopliteal TASC B lesions (класс IIА).
- When revascularization in the infrapopliteal segment is indicated, the endovascular-first strategy should be considered (класс IIА).
- Stem cell/gene therapy is not indicated (класс IIIС).
- При критической ишемии н/к - If revascularization is impossible, prostanoids may be considered (класс IIb).