ABSTRACT
AIM: The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE: Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
Subject(s)
American Heart Association , Lower Extremity , Peripheral Arterial Disease , Humans , Peripheral Arterial Disease/therapy , Peripheral Arterial Disease/diagnosis , Lower Extremity/blood supply , United States , Cardiology/standardsABSTRACT
AIM: The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE: Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
Subject(s)
American Heart Association , Lower Extremity , Peripheral Arterial Disease , Humans , Peripheral Arterial Disease/therapy , Peripheral Arterial Disease/diagnosis , Lower Extremity/blood supply , United States , Cardiology/standards , Societies, Medical/standardsABSTRACT
Changes in the feet occur with age which can cause pain and other foot pathologies that can lead to falls, foot ulcers and amputation. Some older adults may have difficulty doing foot hygiene due to physical or mental decline such as body habitus, poor vision, arthritic problems to mention a few.1 The presence of PAD creates an increased risk of foot ulcers, leg/foot infection and lower extremity amputation, especially in diabetic patients. PAD is often asymptomatic;2 however PAD prevalence increases with age, the majority of which occurs over age 65.3 African-American and Native Americans have approximately twice the prevalence of PAD than that of non-Hispanic Whites.4 There is a 40% rate of death at 5 years following the development of a foot ulcer in PAD patients.5 Foot ulcers require increased medical office visits, increased resource utilization, increased patient anxiety/depression and reduced quality of life (QOL).6 However, routine foot examinations and educating patients and their families in proper footcare can detect common foot problems, uncover functional decline and PAD, and prevent falls. In patients at-risk for foot ulcers, a yearly comprehensive foot evaluation can prevent foot ulcers, foot pain, and lower extremity amputation. Evaluation and early recognition of PAD can reduce morbidity and mortality.6,8,13.
Subject(s)
Diabetic Foot , Peripheral Arterial Disease , Humans , Aged , Child, Preschool , Quality of Life , Peripheral Arterial Disease/complications , Lower Extremity , PainABSTRACT
This article focuses on peripheral arterial disease (PAD) of the lower extremities. There is a higher incidence of myocardial infarction, stroke, and cardiovascular death, resulting in higher rates of all-cause mortality compared with patients without PAD. Thus, the presence of PAD is a marker for systemic atherosclerotic disease and can lead to the early detection and treatment of coronary artery disease or cerebrovascular disease. This article reviews the latest information about the prevalence, symptoms, classification, diagnosis, and treatment of PAD. Monitoring and detection of PAD are also discussed, including implications for nursing care.
Subject(s)
Cardiovascular Nursing , Peripheral Arterial Disease , Humans , Risk Factors , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/therapyABSTRACT
Stem cell research has been discussed in both the political and popular arenas lately. Some types of stem cell research are controversial; however, not all stem cell research involves harvesting cells from an embryo or an aborted fetus. Another type of stem cell, the adult stem cell, resides within tissues and organs of the body and is responsible for repair after injury. Recent interest has focused on using adult stem cells isolated from a patient's bone marrow to stimulate the development of new blood vessels (a process called angiogenesis) in patients with peripheral vascular disease. These specialized stem cells are referred to as endothelial progenitor cells (EPCs). In laboratory and clinical studies it has been shown that these EPCs are involved in arterial repair and remodeling, as well as angiogenesis. The following case presentation will show how a patient with an ischemic toe ulcer and rest pain, who had no options for conventional revascularization, benefited from the injection of stem cells into her calf muscle. The process of angiogenesis using EPCs will be examined discussing the screening criteria and possible adverse events. The patient's history and progress throughout the recovery period will be reviewed.
Subject(s)
Foot Ulcer/therapy , Hematopoietic Stem Cell Transplantation/methods , Aged , Angiography , Female , Foot/blood supply , Foot Ulcer/diagnosis , Foot Ulcer/etiology , Hematopoietic Stem Cell Transplantation/nursing , Humans , Hypertension/complications , Ischemia/complications , Mass Screening , Mobility Limitation , Neovascularization, Physiologic , Nursing Assessment/methods , Patient Selection , Preoperative Care/methods , Smoking/adverse effects , Treatment Outcome , Ultrasonography, DopplerABSTRACT
Hypertension (HTN) is a major risk factor for cardiovascular disease. About 80 million U.S. adults (33%) have HTN. Of these individuals, approximately 77% use antihypertensive medication, however, only 54% have controlled HTN. Studies have demonstrated that patients whose blood pressures are controlled achieve a minimum of 50% reduction in cardiovascular events compared to similar patients with poorly controlled blood pressure. This article will define HTN and its consequences. Diagnostic evaluation and evidence-based treatment guidelines for HTN to include lifestyle modifications and pharmacotherapy will be discussed. Finally, this article will examine why the treatment of HTN can prevent the development and reduce the progression of atherosclerosis in vascular disease.
Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Guideline Adherence/standards , Hypertension/complications , Hypertension/therapy , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Cardiovascular Diseases/etiology , Humans , Hypertension/drug therapy , Life Style , Risk FactorsABSTRACT
Cardiovascular disease is the leading cause of disability and death in the United States. Although the role of lipids in the atherosclerotic process is well established, the management of dyslipidemia is often suboptimal. The National Cholesterol Education Program and its Adult Treatment Panel III have established treatment guidelines for dyslipidemia. This article will define the problem of dyslipidemia in vascular patients and discuss the recommendations of the National Cholesterol Education Program and Adult Treatment Panel III and the implications for health care personnel.
Subject(s)
Hyperlipidemias/therapy , Vascular Diseases/complications , Anticholesteremic Agents/therapeutic use , Arteriosclerosis/physiopathology , Arteriosclerosis/prevention & control , Diet, Fat-Restricted , Humans , Hyperlipidemias/complications , Hyperlipidemias/physiopathology , Risk AssessmentABSTRACT
Hypertension (HTN), the leading cause of morbidity and mortality worldwide, is a modifiable risk factor for atherosclerosis. However, all too often, HTN is not well controlled in patients with vascular disease. Studies have demonstrated that patients whose blood pressure is controlled achieve at least a 50% reduction in cardiovascular events compared with similar patients whose blood pressure is not controlled. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recently prepared and distributed new guidelines for the management of HTN. This article will highlight the new recommendations for HTN management and how they can be applied to the patient with vascular disease.
Subject(s)
Hypertension/complications , Hypertension/therapy , Vascular Diseases/complications , Antihypertensive Agents/therapeutic use , Cardiovascular Diseases/prevention & control , Humans , Hypertension/diagnosis , Life Style , Practice Guidelines as Topic , Risk FactorsABSTRACT
Acute lower extremity ischemia (ALEI) is a recognized complication of coronary revascularization that can lead to emergent lower extremity revascularization, amputation, and death. Patients with correctable coronary artery disease have a high incidence of lower extremity arterial occlusive disease (AOD). But, despite the known high correlation between AOD and coronary artery disease, the status of the lower extremity vasculature in patients undergoing coronary revascularization may be overlooked until the lower extremity becomes profoundly ischemic. Data from a retrospective review of 35,000 coronary revascularization procedures identified 55 patients who developed ALEI, subsequent to their cardiac procedures. Risk factors for ALEI included femoral artery instrumentation, previous coronary revascularization, hemodynamic instability, and documented AOD. Means of identifying patients at risk for ALEI are discussed.