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

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. I IIa IIb III B

Post-Surgical Care for the Individual With PAD: Autogenous Vein Bypass IIa IIb III A 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.

Post-Surgical Care for the Individual With PAD: Synthetic Vein Bypass IIa IIb III A 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.

Post-Surgical Care for the Individual With PAD: Critical Limb Ischemia IIa IIb III C 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.

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

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

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.

The Ideal Clinical Synergy: When an Informed Patient Seeks an Informed Clinician The PAD Coalition & PAD Guideline Public Awareness of Peripheral Artery Disease Clinician Awareness of Peripheral Artery Disease Individual “at risk” or with PAD seeks care (primary care) Individual “at risk” or with PAD receives vascular care

public and physician education. 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/

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

“Stay in Circulation: Take Steps to Learn About PAD” 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