Management of chronic limb ischemia in lower extremity peripheral arterial disease
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 Management of CLI (critical limb ischemia) in the Patient With PAD
Recommendation for Revascularization for CLI
Class IIa |
"1. In patients with CLI, revascularization should be performed when possible to minimize tissue loss ( (Level of Evidence: B-NR)" |
"2. An evaluation for revascularization options should be performed by an interdisciplinary care team before amputation in the patient with CLI(Level of Evidence: C-EO)" |
Recommendations for Endovascular Revascularization for CLI
Class I |
"1.Endovascular procedures are recommended to establish in-line blood flow to the foot in patients with nonhealing wounds or gangrene (Level of Evidence: B-R)" |
Class IIa |
"1. A staged approach to endovascular procedures is reasonable in patients with ischemic rest pain (Level of Evidence: C-LD)" |
"2. Evaluation of lesion characteristics can be useful in selecting the endovascular approach for CLI(Level of Evidence: B-R)" |
Class IIb |
"1.Use of angiosome-directed endovascular therapy may be reasonable for patients with CLI and nonhealing wounds or gangrene (Level of Evidence: C-LD)" |
Recommendations for Surgical Revascularization for CLI
Class I |
"1. When surgery is performed for CLI, bypass to the popliteal or infrapopliteal arteries (i.e., tibial, pedal) should be constructed with suitable autogenous vein(Level of Evidence: A)" |
"2. Surgical procedures are recommended to establish in-line blood flow to the foot
in patients with nonhealing wounds or gangrene (Level of Evidence: C-LD)" |
Class IIa |
"1. In patients with CLI for whom endovascular revascularization has failed and a suitable autogenous vein is not available, prosthetic material can be effective for
bypass to the below-knee popliteal and tibial arteries (Level of Evidence: B-NR)" |
"2. A staged approach to surgical procedures is reasonable in patients with ischemic rest pain (Level of Evidence: C-LD)" |
Recommendation for Wound Healing Therapy
Class I |
"1. An interdisciplinary care team should evaluate and provide comprehensive care for patients with CLI and tissue loss to achieve complete wound healing and a functional foot(Level of Evidence: B-NR)" |
"2. In patients with CLI, wound care after revascularization should be performed with the goal of complete wound healing(Level of Evidence: C-LD)" |
Class III (Harm) |
"1. RECOMMENDATION 1 HERE (Level of Evidence: C)" |
Class IIa |
"1. RECOMMENDATION 1 HERE (Level of Evidence: C)" |
"2. RECOMMENDATION 2 HERE (Level of Evidence: C)" |
References
- ↑ 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.