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  • Conte, Michael S.Univ Calif San Francisco, Div Vasc & Endovasc Surg, 400 Parnassus Ave,Ste A581, San Francisco, CA 94143 USA (författare)

Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia

  • Artikel/kapitelEngelska2019

Förlag, utgivningsår, omfång ...

  • Saunders Elsevier,2019
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-390918
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-390918URI
  • https://doi.org/10.1016/j.ejvs.2019.05.006DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Correction in: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Volume: 59, Issue: 3, Pages: 492-493, DOI: 10.1016/j.ejvs.2019.11.025Correction in: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Volume: 60, Issue: 1, Pages: 158-159, DOI: 10.1016/j.ejvs.2020.04.033
  • 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.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Bradbury, Andrew W.Univ Birmingham, Dept Vasc Surg, Birmingham, W Midlands, England (författare)
  • Kolh, PhilippeUniv Hosp Liege, Dept Biomed & Preclin Sci, Wallonia, Belgium (författare)
  • White, John, VAdvocate Lutheran Gen Hosp, Dept Surg, Niles, IL USA (författare)
  • Dick, FlorianKantonsspital St Gallen, Dept Vasc Surg, St Gallen, Switzerland;Univ Bern, Bern, Switzerland (författare)
  • Fitridge, RobertUniv Adelaide, Med Sch, Dept Vasc & Endovasc Surg, Adelaide, SA, Australia (författare)
  • Mills, Joseph L.Baylor Coll Med, Div Vasc Surg & Endovasc Therapy, Houston, TX 77030 USA (författare)
  • Ricco, Jean-BaptisteUniv Hosp Poitiers, Dept Clin Res, Poitiers, France (författare)
  • Suresh, Kalkunte R.Jain Inst Vasc Sci, Bangalore, Karnataka, India (författare)
  • Murad, M. HassanMayo Clin, Evidence Based Practice Ctr, Rochester, MN USA (författare)
  • Aboyans, VictorUniv Hosp, Dept Cardiol, Dupuytren, France (författare)
  • Aksoy, MuratAmer Hosp, Dept Vasc Surg, Istanbul, Turkey (författare)
  • Alexandrescu, Vlad-AdrianUniv Liege, CHU Sart Tilman Hosp, Liege, Belgium (författare)
  • Armstrong, DavidUniv Southern Calif, Los Angeles, CA USA (författare)
  • Azuma, NobuyoshiAsahikawa Med Univ, Asahikawa, Hokkaido, Japan (författare)
  • Belch, JillUniv Dundee, Ninewells Hosp, Dundee, Scotland (författare)
  • Bergoeing, MichelPontificia Univ Catolica Chile, Escuela Med, Santiago, Chile (författare)
  • Björck, MartinUppsala universitet,Kärlkirurgi(Swepub:uu)mabjo425 (författare)
  • Chakfe, NabilUniv Hosp Strasbourg, Strasbourg, France (författare)
  • Cheng, StephenUniv Hong Kong, Hong Kong, Peoples R China (författare)
  • Dawson, JosephRoyal Adelaide Hosp, Adelaide, SA, Australia;Univ Adelaide, Adelaide, SA, Australia (författare)
  • Debus, Eike S.Univ Hosp Hamburg Eppendorf, Univ Heart Ctr Hamburg, Hamburg, Germany (författare)
  • Dueck, AndrewUniv Toronto, Schulich Heart Ctr, Sci Ctr, Sunnybrook Hlth, Toronto, ON, Canada (författare)
  • Duval, SusanUniv Minnesota, Med Sch, Cardiovasc Div, Minneapolis, MN 55455 USA (författare)
  • Eckstein, Hans H.Tech Univ Munich, Munich, Germany (författare)
  • Ferraresi, RobertoIst Clin, Intervent Cardiovasc Unit, Cardiol Dept, Milan, Italy (författare)
  • Gambhir, RaghvinderKings Coll Hosp London, London, England (författare)
  • Garguilo, MauroUniv Bologna, Diagnost & Sperimentale, Bologna, Italy (författare)
  • Geraghty, PatrickWashington Univ, Sch Med, St Louis, MO USA (författare)
  • Goode, SteveSheffield Vasc Inst, Sheffield, S Yorkshire, England (författare)
  • Gray, BruceGreenville Hlth Syst, Greenville, SC USA (författare)
  • Guo, Wei301 Gen Hosp PLA, Beijing, Peoples R China (författare)
  • Gupta, Prem C.Care Hosp, Banjara Hills, Hyderabad, India (författare)
  • Hinchliffe, RobertUniv Bristol, Bristol, Avon, England (författare)
  • Jetty, PrasadOttawa Hosp, Div Vasc & Endovasc Surg, Ottawa, ON, Canada;Univ Ottawa, Ottawa, ON, Canada (författare)
  • Komori, KimihiroNagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan (författare)
  • Lavery, LawrenceUT Southwestern Med Ctr, Dallas, TX USA (författare)
  • Liang, WeiShanghai Jiao Tong Univ, Renji Hosp, Sch Med, Shanghai, Peoples R China (författare)
  • Lookstein, RobertIcahn Sch Med Mt Sinai, Div Vasc & Intervent Radiol, New York, NY 10029 USA (författare)
  • Menard, MatthewBrigham & Womens Hosp, Boston, MA 02115 USA (författare)
  • Misra, SanjayMayo Clin, Rochester, MN USA (författare)
  • Miyata, TetsuroSanno Hosp, Tokyo, Japan;Sanno Med Ctr, Tokyo, Japan (författare)
  • Moneta, GregOregon Hlth & Sci Univ, Portland, OR 97201 USA (författare)
  • Prado, Jose A. MunoaClin Venart, Tuxtla Gutierrez, Mexico (författare)
  • Munoz, AlbertoColombia Natl Univ, Bogota, Colombia (författare)
  • Paolini, Juan E.Univ Buenos Aires, Sanatoria Dr Julio Mendez, Buenos Aires, DF, Argentina (författare)
  • Patel, ManeshDuke Univ Hlth Syst, Div Cardiol, Durham, NC USA (författare)
  • Pomposelli, FrankSt Elizabeths Med Ctr, Boston, MA USA (författare)
  • Powell, RichardDartmouth Hitchcock, Lebanon, NH USA (författare)
  • Robless, PeterMt Elizabeth Hosp, Singapore, Singapore (författare)
  • Rogers, LeeAmputat Prevent Ctr Amer, White Plains, NY USA (författare)
  • Schanzer, AndresUniv Massachusetts, Amherst, MA 01003 USA (författare)
  • Schneider, PeterKaiser Fdn Hosp Honolulu, Honolulu, HI USA;Hawaii Permanente Med Grp, Kahului, HI USA (författare)
  • Taylor, SpenceUSC Sch Med Greenville, Greenville Hlth Ctr, Greenville, SC USA (författare)
  • De Ceniga, Melina, VHosp Galdakao Usansolo, Bizkaia, Spain (författare)
  • Veller, MartinUniv Witwatersrand, Johannesburg, South Africa (författare)
  • Vermassen, FrankGhent Univ Hosp, Ghent, Belgium (författare)
  • Wang, JinsongSun Yat Sen Univ, Affiliated Hosp 1, Guangzhou, Guangdong, Peoples R China (författare)
  • Wang, ShenmingSun Yat Sen Univ, Affiliated Hosp 1, Guangzhou, Guangdong, Peoples R China (författare)
  • Univ Calif San Francisco, Div Vasc & Endovasc Surg, 400 Parnassus Ave,Ste A581, San Francisco, CA 94143 USAUniv Birmingham, Dept Vasc Surg, Birmingham, W Midlands, England (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:European Journal of Vascular and Endovascular Surgery: Saunders Elsevier58:1, s. S1-S1091078-58841532-2165

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