Post-Surgical Care for the Individual With PAD: A Shared Responsibility to Sustain Life and Limb.
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Transcript of Post-Surgical Care for the Individual With PAD: A Shared Responsibility to Sustain Life and Limb.
![Page 1: Post-Surgical Care for the Individual With PAD: A Shared Responsibility to Sustain Life and Limb.](https://reader031.fdocuments.in/reader031/viewer/2022032605/56649e7c5503460f94b7dae9/html5/thumbnails/1.jpg)
Post-Surgical Care for the Individual With PAD:
A Shared Responsibility to Sustain Life and Limb
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Post-Surgical Care for the Individual With PAD
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Unless contraindicated, all patientsundergoing revascularization for CLI should be placed on antiplatelet therapy, and this treatment should be continued indefinitely.
Patients who have undergone placement of aortobifemoral bypass grafts should be followed up with periodic evaluations that record any return or progression of ischemic symptoms, the presence of femoral pulses, and ABIs.
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Post-Surgical Care for the Individual With PAD: Autogenous Vein Bypass
III IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIIaIIaIIa IIbIIbIIb IIIIIIIII Patients who have undergone placement of a lower extremity bypass with autogenous vein should undergo for at least 2 years periodic examinations that record any return or progression of ischemic symptoms; a physical examination, with concentration on pulse examination of the proximal, graft, and outflow vessels; and Duplex imaging of the entire length of the graft, with measurement of peak systolic velocities and calculation of velocity ratios across all lesions.
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Post-Surgical Care for the Individual With PAD: Synthetic Vein Bypass
III IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIIaIIaIIa IIbIIbIIb IIIIIIIII Patients who have undergone placement of a synthetic lower extremity bypass graft should undergo periodic examinations that record any return of ischemic symptoms; a pulse examination of the proximal, graft, and outflow vessels; and assessment of ABIs at rest and after exercise for at least 2 years after implantation.
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Post-Surgical Care for the Individual With PAD: Critical Limb Ischemia
Patients with a prior history of CLI or whohave undergone successful treatment for CLI should be evaluated at least twice annually by a vascular specialist owing to the
relatively high incidence of recurrence.
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The PAD Guideline is Intended to Guide Lifelong Primary to Specialty PAD Care
Population at risk:(Age and risk factors)
Establish the PAD diagnosis
Population with symptoms:Improve limb outcomes
Prevent CV ischemic events
MedicalTherapy
EndovascularTherapy
SurgicalTherapy
Integrated care requires a partnership of vascular specialists (vascular medicine,
cardiology, interventional radiology, nursing, podiatry, and others)
•ABI
•TBI
•Duplex US
•MRA
•CTA
•Angiography
Population remains at risk:
Primary care management of legs and life, in
collaboration withvascular specialists
ABI=ankle-brachial index; CTA=computed tomographic angiography; CV=cardiovascular; MRA=magnetic resonance angiography; TBI=toe-brachial index; US= ultrasound.
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The PAD Guideline:Diverse Platforms For Diverse Users
The Pocket Guide is:
• A concise summary of the key recommendations & clinical algorithms
• Provides the central “to do” goals for each PAD syndrome
• Is appropriate for clinicians in practice and trainees
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• Population at risk is now defined by epidemiologic criteria applied to practice.
• Presentation-specific algorithms will expedite care (e.g., asymptomatic, atypical leg pain, classic claudication, critical limb ischemia, and acute arterial occlusion).
• Use of exercise, pharmacologic, endovascular, and surgical interventions are emplaced in care as defined by evidence.
Intersocietal Guidelines for the Management of PAD:Major Contributions to Improved Care Standards
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Public Awarenessof
Peripheral ArterialDisease
Clinician Awarenessof
Peripheral ArterialDisease
The PAD Coalition & PAD Guideline
Individual “at risk” or with PADseeks care (primary care)
Individual “at risk” or with PADreceives vascular care
The Ideal Clinical Synergy:When an Informed Patient Seeks an Informed Clinician
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The Peripheral Arterial Disease Coalition
Toward Increased Public Awareness and
Education of PAD in North America
The PAD Coalition
A public, interdisciplinary, not-for-profit Coalition devoted to creating a national PAD public awareness campaign and to
coordinating PAD public and physician education.
www.padcoalition.org
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The Peripheral Arterial Disease Coalition
www.PADCoalition.org
Clearinghouse for PAD
educational resources:
• Clinical practice tools
• Slides• Patient
education resources
• Professional meetings
• PAD Coalition news
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The Peripheral Arterial Disease Coalition
www.aboutpad.org
“Stay in Circulation:
Take Steps to Learn About
PAD” Campaign Web
Site
• Community Action Toolkit
• Media Resources
• Fact Sheets• Posters• “Patient
Stories” Video• Radio and print
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