lvrachЛечащий ВрачLechaschi Vrach1560-51752687-1181ООО «Издательство "Открытые системы"»10.51793/OS.2026.29.6.012lvrach-1646Research ArticleВНУТРЕННИЕ БОЛЕЗНИINTERNAL DISEASESМультимодальная коррекция хронической ишемии нижних конечностейMultimodal management of chronic lower extremity ischemiahttps://orcid.org/0000-0001-8146-2263АхметзяновР. В.AkhmetzianovR. V.

Ахметзянов Рустем Вилевич, д.м.н., доцент кафедры сердечно-сосудистой и эндоваскулярной хирургии; сердечно-сосудистый хирург отделения сосудистой хирургии

420012, Казань, ул. Бутлерова, 49

420101, Казань, ул. Карбышева, 12а

Rustem V. Akhmetzianov, Dr. of Sci. (Med.), Associate Professor of the Department of Cardio-Vascular and Endovascular Surgery; cardiovascular surgeon of the Department ofVascular Surgery

49 Butlerova str., Kazan, 420012

12a Karbysheva str., Kazan, 420101

arustemv@mail.ruhttps://orcid.org/0000-0003-3681-0067СухановД. С.SukhanovD. S.

Суханов Дмитрий Сергеевич, д.м.н., клинический фармаколог, доцент кафедры пропедевтики внутренних болезней

194100, Санкт-Петербург, ул. Литовская, 2

Dmitriy S. Sukhanov, Dr. of Sci. (Med.), clinical pharmacologist, Associate Professor of the Department of Propaedeutics of Internal Diseases

2 Litovskaya str., Saint Petersburg, 194100

dmitriysukhanovl@mail.ruКазанский государственный медицинский университет; Межрегиональный клинико- диагностический центрРоссияKazan State Medical University; Interregional Clinical and Diagnostic CenterRussian FederationСанкт-Петербургский государственный педиатрический медицинский университетРоссияSaint Petersburg State Pediatric Medical UniversityRussian Federation202601072026069098Copyright © Ахметзянов Р.В., Суханов Д.С., 20262026Ахметзянов Р.В., Суханов Д.С.Akhmetzianov R.V., Sukhanov D.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.lvrach.ru/jour/article/view/1646

Введение. Хроническая ишемия нижних конечностей, являющаяся основной клинической формой заболеваний периферических артерий, безусловно, представляет собой значимую медико-социальную проблему в современном обществе вследствие ее высокой распространенности, прогрессирующего течения, риска развития критической ишемии и мажорных (высоких) ампутаций и связанной с ними высокой вероятности смерти в краткосрочной перспективе.Цель работы. Целью текущего обзора медицинской литературы явилось описание современных подходов к комплексной мультимодальной коррекции заболеваний периферических артерий с учетом степени доказательности в международных и национальных клинических рекомендациях.Результаты. Проведен анализ результатов эпидемиологических исследований, этиологии и патогенеза хронической ишемии нижних конечностей, а также ее наиболее показательного симптома – перемежающейся хромоты. Описаны актуальные механизмы развития заболевания. Представлен мультимодальный подход и современные тенденции лечения пациентов с хронической ишемией нижних конечностей и перемежающейся хромотой. Оценен анализ механизмов действия, эффекивности и перспектив применения цилостазола в лечении как пациентов с хронической ишемией нижних конечностей, так и с иной патологией.Заключение. Являясь одним из проявлений системного поражения сердечно-сосудистой системы, хроническая ишемия нижних конечностей требует персонифицированного и вместе с тем комплексного подхода с назначением базисной терапии и препаратов, улучшающих периферическую перфузию. Препаратом первого выбора для увеличения дистанции безболевой ходьбы у пациентов с перемежающейся хромотой, обладающим наивысшим уровнем доказательности, является цилостазол. Эффективность и безопасность препарата подтверждается серией плацебо-контролируемых исследований, что обусловливает клинический эффект и улучшение качества жизни у исследуемой когорты пациентов.

Background. Chronic ischemia of the lower extremities, which represents the predominant manifestation of peripheral artery disease, undoubtedly represents a significant public health challenge in contemporary society due to its high prevalence, progressive course, risk of critical ischemia and major amputations, and the associated increased short-term mortality risk. The prevalence of chronic lower extremity ischemia demonstrates sex-specific patterns with an earlier onset and a slightly higher prevalence in men. However, after the age of 75, these sex differences diminish, and the prevalence of this pathology becomes higher in women.Objective. The current review aimed to outline current approaches to the comprehensive multimodal management of peripheral arterial disease, in accordance with the level of evidence in international and national clinical guidelines.Results. An analysis of epidemiological data, etiology, and pathogenesis of chronic lower extremity ischemia was performed, as well as its most hallmark symptom, intermittent claudication. Underlying mechanisms of disease development are described. This review evaluates a multimodal approach and current treatment trends for patients with chronic lower extremity ischemia and intermittent claudication. The review outlines the mechanisms of action, efficacy, and future therapeutic applications of cilostazol for managing patients with chronic lower extremity ischemia, as well as those with other pathologies.Conclusion. Representing one of the manifestations of systemic cardiovascular disease, requires a personalized yet comprehensive approach involving the prescription of maintenance therapy and peripheral perfusion enhancers. Cilostazol, with the highest level of evidence, is the first-line agent for increasing pain-free walking distance in patients with intermittent claudication. The efficacy and safety of cilostazol have been demonstrated in a series of placebo-controlled studies, thereby underlying the clinical efficacy and improved quality of life in the patient cohort.

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The authors declare that there are no conflicts of interest present.