Post-Surgical Care for the Individual With PAD: A Shared Responsibility to Sustain Life and Limb

1. Post-Surgical Care for the Individual With PAD:A Shared Responsibility to Sustain Life and Limb

2. IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I B Post-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.

3. IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I A Post-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.

4. IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I A Post-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.

5. IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I IIa IIa IIa IIa IIb IIb IIb IIb III III III III I I I C Post-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.

6. Integrated care requires a partnership of vascular specialists (vascular medicine, cardiology, interventional radiology, nursing, podiatry, and others) The 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 ABI=ankle-brachial index; CTA=computed tomographic angiography;CV=cardiovascular; MRA=magnetic resonance angiography; TBI=toe-brachial index; US= ultrasound.

7. The PAD Guideline:Diverse 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

8. Intersocietal Guidelines for the Management of PAD:Major 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.

9. The PAD Coalition & PAD Guideline Public Awareness of Peripheral Artery Disease Clinician Awareness of Peripheral Artery Disease The 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

10. Toward 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/

11. www.vasculardisease.org/padcoalition/ • Clearinghouse for PAD educational resources: • Clinical practice tools • Slides • Patient education resources • Professional meetings • PAD Coalition news

12. www.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