Minimizing tissue loss in lower extremity peripheral arterial disease

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AHA/ACC Guidelines on Management of Lower Extremity PAD

Guidelines for Clinical Assessment of Lower Extremity PAD

Guidelines for Diagnostic Testing for suspected PAD

Guidelines for Screening for Atherosclerotic Disease in Other Vascular Beds in patients with Lower Extremity PAD

Guidelines for Medical Therapy for Lower Extremity PAD

Guidelines for Structured Exercise Therapy for Lower Extremity PAD

Guidelines for Minimizing Tissue Loss in Lower Extremity PAD

Guidelines for Revascularization of Claudication in Lower Extremity PAD

Guidelines for Management of CLI in Lower Extremity PAD

Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD

Guidelines for Longitudinal Follow-up for Lower Extremity PAD

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease[1]

Recommendations for Minimizing Tissue Loss in Patients with PAD

Class I
"1. Patients with PAD and diabetes mellitus should be counseled about self–foot examination and healthy foot behaviors.(Level of Evidence: C-LD)"
"2. In patients with PAD, prompt diagnosis and treatment of foot infection are recommended to avoid amputation.(Level of Evidence: C-LD)"
Class IIa
"1.In patients with PAD and signs of foot infection, prompt referral to an interdisciplinary care team (Table 1) can be beneficial.(Level of Evidence: C-LD)"
"2. It is reasonable to counsel patients with PAD without diabetes mellitus about self–foot examination and healthy foot behaviors.(Level of Evidence: C-EO)"
"3. Biannual foot examination by a clinician is reasonable for patients with PAD and diabetes mellitus.(Level of Evidence: C-EO)"
Table1: Interdisciplinary Care Team for PAD*

A team of professionals representing different disciplines to assist in the evaluation and management of the patient with PAD.

  • For the care of patients with CLI, the interdisciplinary care team should include individuals who are skilled in endovascular revascularization, surgical revascularization, wound healing therapies and foot surgery, and medical evaluation and care.
  • Interdisciplinary care team members may include:
    • Vascular medical and surgical specialists (i.e., vascular medicine, vascular surgery, interventional radiology, interventional cardiology)
    • Nurses
    • Orthopedic surgeons and podiatrists
    • Endocrinologists
    • Internal medicine specialists
    • Infectious disease specialists
    • Radiology and vascular imaging specialists
    • Physical medicine and rehabilitation clinicians
    • Orthotics and prosthetics specialists
    • Social workers
    • Exercise physiologists
    • Physical and occupational therapists
    • Nutritionists/dieticians
*Adapted from 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

References

  1. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE; et al. (2016). "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. doi:10.1161/CIR.0000000000000471. PMID 27840333.

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