00:00

Management of Lower Extremity Peripheral Artery Disease: A Clinical Update

This clinical update provides recommendations and guidelines for managing lower extremity peripheral artery disease (PAD). Topics covered include history and physical exam for PAD, imaging techniques, risk factors, medical therapy, preventive foot care, exercise therapy, and revascularization strategies. The document emphasizes a patient-centered approach and highlights the importance of minimizing tissue loss for critical limb ischemia. Evidence gaps and future research directions are also addressed.

choperena
Télécharger la présentation

Management of Lower Extremity Peripheral Artery Disease: A Clinical Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. AHA Clinical Update ADAPTED FROM: 2024 AHA/ACC Guideline on the Management of Lower Extremity Peripheral Artery Disease

  2. Table 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care • • • • • • • • • • • • • • • • • • • • • •COR and LOE are determined independently (any COR may be paired with any LOE). • • • •A recommendation with LOE C does not imply that the recommendation is weak. Many important clinical questions addressed in guidelines do not lend themselves to clinical trials. Although RCTs are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. •*The outcome or result of the intervention should be specified (an improved clinical outcome or increased diagnostic accuracy or incremental prognostic information). • †For comparative-effectiveness recommendation (COR 1 and 2a; LOE A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. • • • • •‡The method of assessing quality is evolving, including the application of standardized, widely-used, and preferably validated evidence grading tools; and for systematic reviews, the incorporation of an Evidence Review Committee. •COR indicates Class of Recommendation; EO, expert opinion; LD, limited data; LOE, Level of Evidence; NR, nonrandomized; R, randomized; and RCT, randomized controlled trial.

  3. Definitions

  4. Recognizing Clinical Subsets of PAD

  5. History and Physical Exam for PAD HISTORY PHYSICAL EXAM • • Claudication • • • • Other non-joint-related exertional lower extremity symptoms (not typical of claudication) or symptoms of impaired walking function • • Ischemic rest pain • History of nonhealing or slow-healing lower extremity wound • Erectile dysfunction

  6. Resting ABI

  7. Exercise ABI and Additional Physiological Testing

  8. Imaging for PAD • • • • • • •

  9. PAD-Related Risk Amplifiers and Health Disparities Increase Risk of MACE and MALE PAD Risk Amplifiers Health Disparities Contributors • • • • • • • • • • • • • • • • • Social Determinants of Health •

  10. Consideration for PAD in Older Patients Frailty Impact of amputation Sarcopenia Mobility impairment Malnutrition Revascularization considerations Polypharmacy Encourage shared decision making to evaluate the utility of endovascular, surgical, or hybrid revascularization procedures

  11. Overview of Medical Therapy and Preventive Footcare for Patients with PAD

  12. Anti-platelet therapy in Patients with PAD 2a 2a 1 1 1 1 2a 2a 2a 2a 1 1 2b 2b 1 1 2b 2b 2b 2b 3: Harm 3: Harm

  13. Medical Therapy in Patients with PAD 1 1 1 1 2a 2a 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2b 2b

  14. Preventive Foot Care and Leg Symptom Management in Patients with PAD 1 1 1 1 1 1 2b 2b 1 1 3: No 3: No Benefit Benefit 1 1 3: Harm 3: Harm 2a 2a

  15. Exercise Therapy for Patients with PAD 1 1 1 1 1 1 2a 2a 1 1 2b 2b

  16. Revascularization for Asymptomatic PAD 2a 2a 3: 3: Harm Harm

  17. Patient-centered Approach to Revascularization Start GDMT and assess response Revascularization consideration Patient-centered discussion • • • • • • • • • • • • • •

  18. Algorithm for Revascularization for Claudication, Chronic Symptomatic PAD

  19. Revascularization for Functionally Limiting Claudication, Recommendations based on Location of Disease 1 1 1 1 2a 2a 2a 2a 2a 2a 2b 2b 2b 2b

  20. Conduit for Surgical Revascularization for Femoropopliteal Disease Functionally limiting claudication Significant femoropopliteal disease Surgical revascularization planned Autogenous vein preferred to prosthetic graft material (Class 1)

  21. Components of Care for CLTI

  22. Revascularization Goals for CLTI 1 1 1 1

  23. Revascularization Strategy for CLTI 1 1 1 1 1 1

  24. Revascularization Strategy for CLTI-continued 2a 2a 2a 2a 2a 2a

  25. Minimizing Tissue Loss for CLTI: Pressure offloading is key 1 1 1 1 2b 2b

  26. Wound Care and Infection for Patients with CLTI 1 1 1 1 2b 2b

  27. “No Option” Patients In patients with CLTI for whom revascularization is not an option: sefulness of prostanoids is uncertain. 2b 2b 2b 2b 2b 2b

  28. Amputation in Patients with CLTI 1 1 1 1 1 1 1 1 2a 2a

  29. ALI Diagnosis and Management

  30. ALI Diagnosis and Management • • • • • • • •

  31. Revascularization for ALI Revascularization Revascularization 1 1 2a 2a 2b 2b 3: Harm 3: Harm

  32. Acute Limb Ischemia Minimizing Tissue Loss Minimizing Tissue Loss Establishing Etiology Establishing Etiology 1 1 1 1 2a 2a 2a 2a 2a 2a

  33. Longitudinal Follow-Up of Patients with PAD 1 1 2a 2a 1 1 1 1 2a 2a 1 1 1 1 2b 2b 1 1 2a 2a

  34. Evidence Gaps Studies to compare telehealth technology vs. facility-based supervised exercise therapy. Clinical trials in asymptomatic patients • • RCT or registry data for chronic symptomatic PAD treated by exercise therapy, endovascular management, and surgical management with hard outcomes, including MACE and MALE. Studies to identify new medical therapies to improve functional Studies to identify new medical therapies to improve functional status status Comparative effectiveness studies of endovascular devices comparing outcomes of different strategies Studies on patients who have undergone revascularization procedures • Studies to determine the ideal timing and modality for vascular Studies to determine the ideal timing and modality for vascular surveillance testing post surveillance testing post- -revascularization procedures. revascularization procedures. Studies on the effect of shared decision-making strategies in the management of chronic symptomatic PAD and CLTI Development of patient-reported metrics of functional status/walking performance for outcome measures of studies of revascularization.

  35. Advocacy Priorities Access to Care/Guideline implementation Access to Care/Guideline implementation Disparities Disparities National Initiatives National Initiatives 2

  36. Acknowledgments Dr. Nicholas Brownell Dr. Trevor Cline Dr. Xing Dai Dr. Eson Ekpo Dr. Prerna Gupta Dr. Joyce Han Dr. Usman Hasnie Dr. Jake Mayfield Dr. Eman Rashed

More Related