Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic) A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation

/pdf/acc-aha-2005-practice-guidelines-for-the-management-of-4ltfid6e9i.pdf

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients. Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing. Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection ...

/pdf/challenges-in-the-treatment-of-chronic-wounds-2jwybcph6f.pdf

Challenges in the Treatment of Chronic Wounds.

https://www.lfb.lv/files/ESVS-AAA-guidelines.pdf

Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.

https://www.srcv.ro/ghiduri/Managementul%20pacientilor%20cu%20boala%20venoasa%20cronica%20-%20Ghidurile%20SVS%20-%20American%20Venous%20Forum.pdf

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)

Objective: The objective of this study was to characterize factors associated with closure of venous leg ulcers (VLUs) in a pooled analysis of subjects from three randomized clinical trials. Methods: Closure of VLUs after treatment with HP802-247, an allogeneic living cell therapy consisting of growth-arrested human keratinocytes and fibroblasts, vs standard therapy with compression bandaging was evaluated in three phase 3 clinical trials of similar design. Two trials enrolled subjects with VLUs ranging from 2 cm to 12 cm in area with 12-week treatment periods; the third trial enrolled subjects with VLUs between >12 cm and #36 cm with a 16-week treatment period. The first trial went to completion but failed to demonstrate a benefit to therapy with HP802-247 compared with placebo, and because of this, the remaining trials were terminated before completion. On the basis of no differences in outcomes between groups, subjects from both HP802-247 and control groups were pooled across all three studies. Cox proportional hazards regression analysis was employed to evaluate factors associated with VLU closure. Results: This analysis included data from 716 subjects with VLU. Factors evaluated for association with healing included age, gender, race, diabetes, glycated hemoglobin level, body mass index, treatment (HP802-247 vs compression alone), and ulcer characteristics including location and area and duration at baseline. In an initial model including all of these putative factors, the following were significant at the P < .10 level: diagnosis of diabetes mellitus, gender, wound location (ankle or leg), baseline wound area, and wound duration at baseline. In a final model including only these factors, all but diabetes mellitus were significant at the P < .05 level. Effect sizes were as follows (hazard ratio [95% confidence interval]): female gender (1.384 [1.134-1.690]), wound location on the leg (1.490 [1.187-1.871]), smaller wound area at baseline (0.907 [0.887-0.927]), and shorter wound duration at baseline (0.971 [0.955-0.987]). Conclusions: Factors associated with VLU lesions including location, area, and duration were important predictors of healing. Women were more likely than men to achieve wound closure. Factors including body mass index, the presence of diabetes mellitus, and higher concentrations of glycated hemoglobin were not significant independent predictors of wound closure in this analysis. (J Vasc Surg: Venous and Lym Dis 2017;5:829-36.) Venous leg ulcers (VLUs) represent a large and growing burden to the U.S. health care system. The prevalence of VLUs in the United States is estimated at 1% to 2% and is expected to increase as we live longer. The cost to the U.S. health care system associated with VLU care is estimated to be in excess of $2.5 billion annually. Treatment of VLU remains challenging. Even with optimal he Division of Vascular Surgery, University of North Carolina School edicine, Chapel Hill; the Division of Vascular Surgery, Section of nd Healing and Tissue Repair, University of Illinois Hospital and h Sciences System, and the Division of Plastic Surgery, Northern University Feinberg School of Medicine, Chicago; the Division scular and Endovascular Surgery, Mt. Sinai West and St. Luke’s Hos, New York; the Department of Dermatology and Cutaneous SurMiller School of Medicine, University of Miami, Miami; the rsity of Freiburg, Freiburg; the Department of Dermatology, Univerf Cologne, Cologne; the Przychodnia Lekarsko-Podologiczno Rehacyjna PODOS, Warsaw; and the Smith & Nephew, Inc, Graduate ol of Biomedical Sciences, University of North Texas Health Science er, and the Department of Pediatrics, University of North Texas h Science Center, Fort Worth. embers of the HP802-247 Study Group are listed in the Appendix ne only). ical trials that serve as the basis for the data reported in this work were d by Smith & Nephew Inc. The Corporation supported the statistical sis for the study, but the study authors performed the analysis and conservative treatment, only 50% to 75% of VLUs will close within 6 months, and of these, 6% to 27% will recur annually. Thus, a substantial proportion of VLUs will become chronic. Currently, it is often difficult to predict which ulcers will fail to heal with current recommended treatment protocols for VLUs. Most previous reports have been based on limited data sets of fewer than interpretation and authorized the final decision to submit the manuscript

Journal of Vascular Surgery: Venous and Lymphatic Disorders SVS and AVF Presidents' perspective.

Patient selection for carotid interventions: Anatomical and comorbid factors

This chapter discusses the evaluation and management of venous ulcers. Successful treatment of venous ulcers depends upon following essential steps as based on current evidence in order to maximize success. These steps include confirming adequate arterial perfusion, eliminating edema, treating infection and biofilm, addressing venous reflux, alleviating venous obstruction, and reducing the impact of host risk factors and comorbidities. Such factors as reduction in obesity, improvement in calf muscle pump dysfunction, elimination of smoking, reduction of standing, and maximizing nutrition remain paramount to healing. Comprehensive wound centers may be better poised to offer this care in a coordinated fashion that helps incorporate a more patient-centric approach.

Wound Care Management for Venous Ulcers

Prevalence of acute deep venous thrombosis and the appropriate indications for the use of color-flow duplex scanning in patients with suspected pulmonary embolism

Publisher Summary Percutaneous mechanical thrombectomy (PMT) refers to the technique in which a catheter utilizing mechanical means can be used independently or coupled with pharmacologic thrombolysis in the treatment of deep vein thrombosis (DVT). PMT offers many benefits in short-term therapy for DVT. Once the diagnosis of DVT is established, the goals of therapy are—prevention of PE, prevention of thrombus propagation, preservation of valvular function, and prevention of postthrombotic syndrome (PTS). Faster thrombus removal, smaller doses of thrombolytic agents, and shorter treatment times translate into improved symptom relief, decreased complications, and more efficient patient care. Additionally, more rapid thrombus resolution can potentially preserve valvular function, and decrease the incidence and severity of PTS. PMT should be considered first line therapy for patients presenting with DVT. Advanced endovascular skills, as well as being well versed in possible complications of PMT, are required to provide safe and effective patient care. Preliminary data shows that treatment with PMT may provide quicker thrombus resolution than catheter-directed thrombolysis (CDT) alone. With an increasing emphasis on minimal invasiveness, recent years have witnessed an endovascular revolution that has ushered in many different types of PMT catheters.

Robert B. McLafferty

Papers

Journal of Vascular Surgery: Venous and Lymphatic Disorders SVS and AVF Presidents' perspective.

Patient selection for carotid interventions: Anatomical and comorbid factors

Wound Care Management for Venous Ulcers

Prevalence of acute deep venous thrombosis and the appropriate indications for the use of color-flow duplex scanning in patients with suspected pulmonary embolism

Percutaneous Mechanical Thrombectomy in the Treatment of Acute Deep Venous Thrombosis