Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia
| Autor: | Florian Dick, Wei Guo, Victor Aboyans, Robert A. Lookstein, Robert J. Hinchliffe, Jean-Baptiste Ricco, Roberto Ferraresi, Vlad-Adrian Alexandrescu, Sue Duval, Kimihiro Komori, Jill J. F. Belch, Martin Björck, Melina Vega de Ceniga, Lawrence A. Lavery, Prasad Jetty, Wei Liang, Manesh R. Patel, Robert Fitridge, Martin Veller, Shenming Wang, Raghvinder Gambhir, Philippe Kolh, Murat Aksoy, Alberto Munoz, Patrick J. Geraghty, Hans-Henning Eckstein, Michel Bergoeing, Peter Schneider, Juan E. Paolini, David G. Armstrong, Andrew Dueck, Frank Vermassen, Richard J. Powell, Steve Goode, Greg Moneta, Nobuyoshi Azuma, Jose A. Munoa Prado, Peter A Robless, Prem C. Gupta, Andres Schanzer, Joseph L. Mills, Lee C. Rogers, Tetsuro Miyata, Frank B. Pomposelli, John V. White, Michael S. Conte, Sanjay Misra, Nabil Chakfe, Joseph Dawson, Spence M. Taylor, Eike Sebastian Debus, Jinsong Wang, Mauro Gargiulo, Bruce H. Gray, Matthew T. Menard, Stephen W.K. Cheng, Andrew W. Bradbury, Kalkunte R Suresh, M. Hassan Murad |
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| Přispěvatelé: | VU University medical center |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_treatment
International Cooperation 030204 cardiovascular system & hematology Severity of Illness Index Global Burden of Disease 0302 clinical medicine Ischemia Prevalence Chronic limb-threatening ischemia 030212 general & internal medicine 610 Medicine & health Societies Medical Gangrene Endovascular intervention Diabetes Endovascular Procedures Critical limb ischemia Limb Salvage Treatment Outcome Bypass surgery Lower Extremity Centre for Surgical Research Practice Guidelines as Topic medicine.symptom Cardiology and Cardiovascular Medicine Practice guideline Evidence-based medicine medicine.medical_specialty Revascularization Article Specialties Surgical 03 medical and health sciences Peripheral Arterial Disease medicine Humans Intensive care medicine Foot ulcer Peripheral artery disease business.industry Clinical study design Vascular surgery medicine.disease Clinical trial Amputation Quality of Life Surgery business |
| Zdroj: | J Vasc Surg Conte, M S, Bradbury, A W, Kolh, P, White, J V, Dick, F, Fitridge, R, Mills, J L, Ricco, J-B, Suresh, K R, Murad, M H, GVG Writing Group Joint guidelines of the Society for Vascular Surgery, Forbes, T L, AbuRahma, A, Anankwah, K, Barshes, N, Bush, R, Dalman, R L, Davies, M, Farber, A, Hingorani, A, Malas, M, Mondy, J S, Rzucidlo, E, Schermerhorn, M, European Society for Vascular Surgery, de Borst, G J, van den Berg, J, Bastos Goncalves, F, Kakkos, S, Koncar, I, Lindholt, J, Sillesen, H, World Federation of Vascular Societies, Muñoz, A, Thiruvengadam, V, Björck, M, Subramaniam, P, Rajaruthnam, P, Bedi, V, Mulaudzi, T, Komori, K, Vidyasagaran, T, Azuma, N, Nicholas Wolfe, J H, Wolfe, J, Jawien, A, Mutirangura, P, Bourke, B, Balcazar, A, Paolini, J E, Cavaye, D, de Luccia, N & Diamant, M 2019, ' Global vascular guidelines on the management of chronic limb-threatening ischemia ', Journal of Vascular Surgery, vol. 69, no. 6, pp. 3S-125S.e40 . https://doi.org/10.1016/j.jvs.2019.02.016 2019, ' Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia ', European Journal of Vascular and Endovascular Surgery, vol. 69, no. 6, pp. 3S-125S.e40 . https://doi.org/10.1016/j.jvs.2019.02.016, https://doi.org/10.1016/j.ejvs.2019.05.006 Journal of Vascular Surgery, 69(6), 3S-125S.e40. Mosby Inc. Eur J Vasc Endovasc Surg |
| ISSN: | 1532-2165 0741-5214 |
| DOI: | 10.1016/j.jvs.2019.02.016 |
| Popis: | Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative. |
| Databáze: | OpenAIRE |
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