Title: Post-Surgical Care for the Individual With PAD: A Shared Responsibility to Sustain Life and Limb
1Post-Surgical Care for the Individual With
PADA Shared Responsibility to Sustain Life and
Limb
2Post-Surgical Care for the Individual With PAD
Unless contraindicated, all patients undergoing
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.
3Post-Surgical Care for the Individual With PAD
Autogenous Vein Bypass
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.
4Post-Surgical Care for the Individual With PAD
Synthetic Vein Bypass
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.
5Post-Surgical Care for the Individual With PAD
Critical Limb Ischemia
Patients with a prior history of CLI or who have
undergone successful treatment for CLI should be
evaluated at least twice annually by a vascular
specialist owing to the relatively high
incidence of recurrence.
6The PAD Guideline is Intended to Guide Lifelong
Primary to Specialty PAD Care
Population remains at risk Primary care
management of legs and life, in collaboration
with vascular specialists
Population at risk (Age and risk
factors) Establish the PAD diagnosis
Population with symptoms Improve limb
outcomes Prevent CV ischemic events
- ABI
- TBI
- Duplex US
- MRA
- CTA
- Angiography
Medical Therapy
Endovascular Therapy
Surgical Therapy
ABIankle-brachial index CTAcomputed
tomographic angiography CVcardiovascular
MRAmagnetic resonance angiography
TBItoe-brachial index US ultrasound.
7The PAD GuidelineDiverse 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
8Intersocietal Guidelines for the Management of
PADMajor Contributions to Improved Care
Standards
- 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.
9The Ideal Clinical Synergy When an Informed
Patient Seeks an Informed Clinician
Individual at risk or with PAD seeks care
(primary care)
Individual at risk or with PAD receives
vascular care
10Toward 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.vasculardisease.org/padcoalition/
11www.vasculardisease.org/padcoalition
- Clearinghouse for PAD educational resources
- Clinical practice tools
- Slides
- Patient education resources
- Professional meetings
- PAD Coalition news
12www.aboutpad.org
- Stay in Circulation Take Steps to Learn About
PAD - Campaign Website
- Community Action Toolkit
- Media Resources
- Fact Sheets
- Posters
- Patient Stories Video
- Radio and print ads