Endovascular Treatment of Peripheral Vascular Disease

Allaqaband, Suhail; Kirvaitis, Romas J.; Jan, M. Fuad; Bajwa, Tanvir

doi:10.1016/j.cpcardiol.2009.05.001

Cited by 29 publications

(31 citation statements)

References 376 publications

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“…Resting ABI measurements are to be classified and reported as [1.4 (noncompressible values), 1.0-1.4 (normal), 0.90-0.99 (borderline), and \0.9 (abnormal) according to the Ankle Brachial Index Collaboration [19]. An ABI \0.9 is considered as highly sensitive (95 %) and specific (100 %) for the diagnosis of PAD [20]. In case of noncompressible vessels, the ToeBrachial Index (TBI) may be used instead (critical level \50 mmHg) [4].…”

Section: Clinical Assessmentmentioning

confidence: 99%

“…Supervised exercise therapy has been shown to increase walking distance in claudicants and is recommended as first management of claudicants in combination with best medical therapy [3,23,24]. Pharmacotherapy with daily cilostazol, naftidrofuryl, or pentoxyfilline has also been shown to increase walking distance in claudicants [3,20]. Patients who are obese (BMI [30) or overweight (BMI [25) should be counselled to restrict calorie intake and increase exercise to lose weight.…”

Section: Conservative Therapymentioning

confidence: 99%

“…Emerging evidence from the CHARISMA clinical trial suggests that a combination of aspirin and clopidogrel is more beneficial in reducing adverse vascular events and may be offered to high-risk PAD patients who are at low risk for bleeding [29,30]. Recommended best medical therapy for PAD is summarized in Table 2 [20,23,24,31,32].…”

Section: Conservative Therapymentioning

confidence: 99%

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Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

Κατσάνος

Tepe

Tsetis

et al. 2014

Cardiovasc Intervent Radiol

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This is a Standards of Practice document endorsed by CIRSE. The authors performed a literature review and provide recommendations and quality improvement guidelines based on the most recent and highest level of evidence available to date on the field of Superficial Femoral and Popliteal Artery Angioplasty and Stenting. Standards for the use of basic and more advanced endovascular techniques in the femoropopliteal arteries are reported and relevant aspects of case selection, imaging, follow-up, and overall patient management are presented to guide endovascular practice in Europe.

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Section: Clinical Assessmentmentioning

confidence: 99%

Section: Conservative Therapymentioning

confidence: 99%

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Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

Κατσάνος

Tepe

Tsetis

et al. 2014

Cardiovasc Intervent Radiol

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“…Acute limb ischaemia is distinct from 'critical limb ischaemia', a severe form of chronic ischaemia that includes gangrene and rest pain. Restoration of flow in an acutely ischaemic limb can be attempted by surgical revascularisation (embolectomy, endarterectomy or bypass grafts) or pharmacological dissolution of thrombus [14,16]. Fasciotomy (if there are signs of compartment syndrome) or even amputation may be necessary.…”

Section: Acute Lower Limb Ischaemiamentioning

confidence: 99%

Anaesthesia for vascular emergencies

Ellard¹,

Djaiani

2012

Anaesthesia

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SummaryPatients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management. In-hospital mortality after open repair of ruptured abdominal aortic aneurysm (rAAA) approaches 40-50% with total mortality, including pre-hospital deaths, closer to 80% [1][2][3]. Traumatic thoracic aortic injury is often immediately fatal with a 30-40% mortality in those who arrive alive to hospital and an overall mortality of 90% [4]. Thirty-day mortality rates are > 50% following ruptured thoracic aneurysm [5], 13% for acute type B dissection [6] and > 25% following embolectomy for acute limb ischaemia [7,8].We define a 'vascular emergency', for the purpose of this review, as an acute condition requiring intervention within hours, involving the descending aorta and its main lower limb branches. Specific pathologies meeting these criteria include acute aortic syndrome, ruptured thoracic and abdominal aneurysms, traumatic injuries of the thoracic aorta and acute lower limb ischaemia. Pathology involving the ascending aorta or aortic arch that is generally managed by cardiac surgeons is excluded.This review aims to discuss the optimal anaesthetic management to minimise morbidity and mortality and the impact of a move towards endovascular repair. An English language electronic search using Medline and Embase databases identified relevant scientific literature from the last 10 years and was supplemented with a manual search of reference lists from reviewed articles. Overview of vascular emergenciesAcute aortic syndrome Acute aortic syndrome consists of three interrelated conditions: penetrating atherosclerotic ulcer; intramural haematoma; and aortic dissection. Penetrating athero-

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“…people in the United States. An additional 20 to 30 million Americans have asymptomatic PAD (Allaqaband, Solis, Kazemi, & Bajwa, 2006;Hirsch & Criqui, 2001). Patients affected with the disease have an increased risk of cardiovascular events and mortality.…”

Section: Introductionmentioning

confidence: 99%