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FältnamnIndikatorerMetadata
00006487naa a2201069 4500
001oai:DiVA.org:uu-404277
003SwePub
008200217s2019 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4042772 URI
0247 a https://doi.org/10.1016/j.jvs.2019.02.0162 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Conte, Michael S4 aut
2451 0a Global vascular guidelines on the management of chronic limb-threatening ischemia.
264 1b Elsevier BV,c 2019
338 a print2 rdacarrier
520 a 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.
653 a Bypass surgery
653 a Chronic limb-threatening ischemia
653 a Critical limb ischemia
653 a Diabetes
653 a Endovascular intervention
653 a Evidence-based medicine
653 a Foot ulcer
653 a Peripheral artery disease
653 a Practice guideline
7001 a Bradbury, Andrew W4 aut
7001 a Kolh, Philippe4 aut
7001 a White, John V4 aut
7001 a Dick, Florian4 aut
7001 a Fitridge, Robert4 aut
7001 a Mills, Joseph L4 aut
7001 a Ricco, Jean-Baptiste4 aut
7001 a Suresh, Kalkunte R4 aut
7001 a Murad, M Hassan4 aut
7001 a Aboyans, Victor4 aut
7001 a Aksoy, Murat4 aut
7001 a Alexandrescu, Vlad-Adrian4 aut
7001 a Armstrong, David4 aut
7001 a Azuma, Nobuyoshi4 aut
7001 a Belch, Jill4 aut
7001 a Bergoeing, Michel4 aut
7001 a Björck, Martinu Uppsala universitet,Kärlkirurgi4 aut0 (Swepub:uu)mabjo425
7001 a Chakfé, Nabil4 aut
7001 a Cheng, Stephen4 aut
7001 a Dawson, Joseph4 aut
7001 a Debus, Eike Sebastian4 aut
7001 a Dueck, Andrew4 aut
7001 a Duval, Susan4 aut
7001 a Eckstein, Hans Henning4 aut
7001 a Ferraresi, Roberto4 aut
7001 a Gambhir, Raghvinder4 aut
7001 a Gargiulo, Mauro4 aut
7001 a Geraghty, Patrick4 aut
7001 a Goode, Steve4 aut
7001 a Gray, Bruce4 aut
7001 a Guo, Wei4 aut
7001 a Gupta, Prem Chand4 aut
7001 a Hinchliffe, Robert4 aut
7001 a Jetty, Prasad4 aut
7001 a Komori, Kimihiro4 aut
7001 a Lavery, Lawrence4 aut
7001 a Liang, Wei4 aut
7001 a Lookstein, Robert4 aut
7001 a Menard, Matthew4 aut
7001 a Misra, Sanjay4 aut
7001 a Miyata, Tetsuro4 aut
7001 a Moneta, Greg4 aut
7001 a Prado, Jose Antonio Munoa4 aut
7001 a Munoz, Alberto4 aut
7001 a Paolini, Juan Esteban4 aut
7001 a Patel, Manesh4 aut
7001 a Pomposelli, Frank4 aut
7001 a Powell, Richard4 aut
7001 a Robless, Peter4 aut
7001 a Rogers, Lee4 aut
7001 a Schanzer, Andres4 aut
7001 a Schneider, Peter4 aut
7001 a Taylor, Spence4 aut
7001 a Vega De Ceniga, Melina4 aut
7001 a Veller, Martin4 aut
7001 a Vermassen, Frank4 aut
7001 a Wang, Jinsong4 aut
7001 a Wang, Shenming4 aut
7102 a Uppsala universitetb Kärlkirurgi4 org
7730 t Journal of Vascular Surgeryd : Elsevier BVg 69:6S, s. 3S-125S.e40q 69:6S<3S-125S.e40x 0741-5214x 1097-6809
8564 u http://www.jvascsurg.org/article/S0741521419303210/pdf
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-404277
8564 8u https://doi.org/10.1016/j.jvs.2019.02.016

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