RESUMO
Advances made in medical management and treatment options in addressing lower extremity claudication and vascular disease have skyrocketed during the last decade. Given the recent advances in treatment options, there is often the perception within the medical community and general community that to get the most "cutting edge" treatment, one must go to an academic center or practitioner. The goal of this portion of the discussion is to explore the question of what differences in treatment options there are between a community practice and an academic practice within those members of the vascular surgery specialty. Are there really any differences in the types of treatments offered or availability of the different modalities, and what drives us as practitioners to one over the other?
Assuntos
Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Claudicação Intermitente/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Centros Médicos Acadêmicos/organização & administração , Terapia Combinada , Serviços de Saúde Comunitária/economia , Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde , Humanos , Claudicação Intermitente/classificação , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/economia , Equipe de Assistência ao Paciente/organização & administração , Doença Arterial Periférica/classificação , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/economia , Resultado do TratamentoRESUMO
Intermittent claudication is a symptom complex associated with atherosclerosis of the aorta and lower extremities. It is a clinical marker of systemic atherosclerosis, and therefore, management cannot be considered isolated from treatment of underlying risk factors of atherosclerosis. The focus of the management is twofold. The first is to reduce morbidity and mortality from cardiovascular events, including myocardial infarction and stroke. The second focus is to improve the functional status of patients who have impairment of daily activities secondary to symptoms of claudication through pharmacologic and rehabilitative means, that is, exercise. Exercise is the cornerstone of therapy. A conservative approach is favored in patients who have mild and moderate symptoms of claudication. Intervention with percutaneous techniques or surgery is generally reserved for patients who have severe impairment of lifestyle or threatened tissue.