Management of acute limb ischemia in lower extremity peripheral arterial disease: Difference between revisions
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==Recommendations for Management of Acute Limb Ischemia (ALI)== | ==Recommendations for Management of Acute Limb Ischemia (ALI)== | ||
===Recommendations for Clinical Presentation of ALI=== | ===Recommendations for Clinical Presentation of ALI:=== | ||
{|class="wikitable" | {|class="wikitable" | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients with ALI should be emergently evaluated by a clinician with sufficient experience to assess limb viability and implement appropriate therapy''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients with ALI should be emergently evaluated by a clinician with sufficient experience to assess limb viability and implement appropriate therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with suspected ALI, initial clinical evaluation should rapidly assess limb viability and potential for salvage and does not require imaging | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with suspected ALI, initial clinical evaluation should rapidly assess limb viability and potential for salvage and does not require imaging. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | ||
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|} | |} | ||
===Recommendation for Medical Therapy of ALI=== | ===Recommendation for Medical Therapy of ALI:=== | ||
{|class="wikitable" style="width:82%" | {|class="wikitable" style="width:82%" | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In patients with ALI, systemic anticoagulation with heparin should be administered unless contraindicated''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In patients with ALI, systemic anticoagulation with heparin should be administered unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki> | ||
|- | |- | ||
|} | |} | ||
===Recommendations for Revascularization for ALI=== | ===Recommendations for Revascularization for ALI:=== | ||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In patients with ALI, the revascularization strategy should be determined by local resources and patient factors (e.g., etiology and degree of ischemia''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In patients with ALI, the revascularization strategy should be determined by local resources and patient factors (e.g., etiology and degree of ischemia).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Catheter-based thrombolysis is effective for patients with ALI and a salvageable limb''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Catheter-based thrombolysis is effective for patients with ALI and a salvageable limb. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''Amputation should be performed as the first procedure in patients with a | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''Amputation should be performed as the first procedure in patients with a non salvageable limb. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''Patients with ALI should be monitored and treated (e.g., fasciotomy) for compartment syndrome after revascularization ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''Patients with ALI should be monitored and treated (e.g., fasciotomy) for compartment syndrome after revascularization. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with ALI with a salvageable limb, percutaneous mechanical thrombectomy can be useful as adjunctive therapy to thrombolysis ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with ALI with a salvageable limb, percutaneous mechanical thrombectomy can be useful as adjunctive therapy to thrombolysis. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''In patients with ALI due to embolism and with a salvageable limb, surgical thromboembolectomy can be effective''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''In patients with ALI due to embolism and with a salvageable limb, surgical thromboembolectomy can be effective.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | ||
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===Recommendations for Diagnostic Evaluation of the Cause of ALI=== | ===Recommendations for Diagnostic Evaluation of the Cause of ALI:=== | ||
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Revision as of 19:55, 22 November 2016
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 Acute Limb Ischemia (ALI)
Recommendations for Clinical Presentation of ALI:
Class I |
"1. Patients with ALI should be emergently evaluated by a clinician with sufficient experience to assess limb viability and implement appropriate therapy. (Level of Evidence: C-EO)" |
"2. In patients with suspected ALI, initial clinical evaluation should rapidly assess limb viability and potential for salvage and does not require imaging. (Level of Evidence: C-LD)" |
Recommendation for Medical Therapy of ALI:
Class I |
"1. In patients with ALI, systemic anticoagulation with heparin should be administered unless contraindicated. (Level of Evidence: C-EO)" |
Recommendations for Revascularization for ALI:
Class I |
"1. In patients with ALI, the revascularization strategy should be determined by local resources and patient factors (e.g., etiology and degree of ischemia).(Level of Evidence: C-LD)" |
"2.Catheter-based thrombolysis is effective for patients with ALI and a salvageable limb. (Level of Evidence: A)" |
"3.Amputation should be performed as the first procedure in patients with a non salvageable limb. (Level of Evidence: C-LD)" |
"4.Patients with ALI should be monitored and treated (e.g., fasciotomy) for compartment syndrome after revascularization. (Level of Evidence: C-LD)" |
Class IIa |
"1. In patients with ALI with a salvageable limb, percutaneous mechanical thrombectomy can be useful as adjunctive therapy to thrombolysis. (Level of Evidence: B-NR)" |
"2.In patients with ALI due to embolism and with a salvageable limb, surgical thromboembolectomy can be effective.(Level of Evidence: C-LD)" |
Class IIb |
"1. The usefulness of ultrasound-accelerated catheter-based thrombolysis for patients with ALI with a salvageable limb is unknown. (Level of Evidence: C-LD)" |
Recommendations for Diagnostic Evaluation of the Cause of ALI:
Class I |
"1. In the patient with ALI, a comprehensive history should be obtained to determine the cause of thrombosis and/or embolization.(Level of Evidence: C-EO)" |
Class IIa |
"1. In the patient with a history of ALI, testing for a cardiovascular cause of thromboembolism can be useful. (Level of Evidence: C-EO)" |
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.