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

Wilkins, Lippincott Williams

doi:10.1161/circulationaha.106.173994

Cited by 131 publications

(4 citation statements)

References 440 publications

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“…The patient tolerated the procedure well and was discharged from the hospital. She did not need any small or large intestinal resection which is usually expected even after a successful percutaneous intervention [1] re-iterating the importance of timely successful intervention in this patient population to prevent major morbidity and mortality.…”

mentioning

confidence: 73%

Superior mesenteric artery thrombosis managed percutaneously by timely combining aspiration thrombectomy with angioplasty and stents

Gupta

Chimpiri

Saucedo

2009

J Thromb Thrombolysis

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A 65 years old woman with hypertension, diabetes mellitus and history of coronary artery bypass grafting presented with abdominal pain, nausea, vomiting since two days and one day history of maroon colored bowel movements. Her blood pressure was 190/100 and her abdomen was diffusely tender. Urgent CT scan with intravenous contrast detected thrombosis of the Superior Mesenteric Artery (SMA) but no bowel wall edema or pneumatosis intestinalis (air within bowel wall). The patient, therefore, underwent emergent, percutaneous intervention consisting of a challenging aspiration thrombectomy followed successfully by angioplasty and bare metal stent placement. The patient tolerated the procedure well and was discharged from the hospital. She did not need any small or large intestinal resection which is usually expected even after a successful percutaneous intervention [1] re-iterating the importance of timely successful intervention in this patient population to prevent major morbidity and mortality. DiscussionAcute thrombo-embolic occlusion of the SMA leads to intestinal infarction and is associated with a mortality rate of around 65% [2]. The key to salvage ischemic bowel and prevent patient death is rapid revascularization as well as early diagnosis before bowel ischemia progresses to irreversible bowel necrosis. Therefore, early clinical and radiological diagnosis and appropriate treatment is required for a good prognosis. The primary goal of therapy is rapid and complete restoration of SMA flow and hopefully preserve entire bowel viability. Surgery such as SMA embolectomy, revascularization, SMA bypass, and resection of necrotic bowel, have been attempted, but the peri-operative mortality still remains more than 50% [3]. Failed thrombolysis has been a well-known phenomenon in acute phases and is directly connected with bowel necrosis followed by urgent laparotopy and/or patient death. Adjunctive balloon angioplasty with failed thrombolysis has been reported [4] but use has not popularized due to the fear of distal embolization. On the other hand, a well timed combined use of aspiration thrombectomy with angioplasty and stent could prove safe, effective and relatively longer term solution considering risk factor control remains optimum.Regarding our patient; with more than a day of symptom history, we thought it was too late for effective thrombolysis. And although the proximal site of the SMA and major branches was found to be occluded in our patient, signs of bowel necrosis on abdominal CT or X-Ray (for e.g. bowel wall edema or pneumatosis intestinalis) had not yet developed. This led the team decision towards relatively

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mentioning

confidence: 73%

Superior mesenteric artery thrombosis managed percutaneously by timely combining aspiration thrombectomy with angioplasty and stents

Gupta

Chimpiri

Saucedo

2009

J Thromb Thrombolysis

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“…TPA is useful in maintaining the patency of vessels in select cases of ALI and can be administered in accordance with the American College of Cardiology/American Heart Association (ACC/AHA) 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease [8][9][10]. Studies suggest that thrombolysis is an effective and safe first-line treatment in cases of ALI, and the eligibility of patients as well as the correct infusion technique are essential elements for the success of this intervention [9][10][11][12]. The safety and efficacy of alteplase in particular have further been demonstrated by multiple studies advocating its use in this case [10,[13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Waist Training Corset: An Unusual Cause of Acute Lower Limb Ischemia

Ramcharan

Hanandeh

Donaldson

et al. 2020

Cureus

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Acute limb ischemia (ALI) can occur due to many causes. This article illustrates a novel case of a very rare presentation and etiology of acute lower extremity ischemia. This case involves a middle-aged female with a history of smoking and obesity who presented with right lower extremity (RLE) pain. The patient had undergone a liposuction procedure a few days prior to her presentation and had been wearing a waist training corset. The patient was found to have multivessel thrombotic occlusive plaques starting from the right common iliac to the right tibial arteries. She was fully worked up and no other etiologies of her presentation was found. Thus, we concluded that her presentation was very likely precipitated by wearing the training corset, leading to right iliac artery thrombosis or perhaps a formal iliac atherosclerotic plaque destabilization and ipsilateral limb showering with athero-thrombi.

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“…We will start our search in 2006 as this is the year after publication of the first PAD treatment clinical practice guideline by ACC/AHA. 38 To identify additional citations, we will use the PubMed ‘related articles’ feature and manually search bibliographies of included studies and relevant review articles identified during the search.…”

Section: Methodsmentioning

confidence: 99%

Evidence for clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications among adults with peripheral artery disease: protocol for a systematic review and meta-analysis

de Launay,

Paquet,

Kirkham

et al. 2024

BMJ Open

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IntroductionInternational guidelines recommend that adults with peripheral artery disease (PAD) be prescribed antiplatelet, statin and antihypertensive medications. However, it is unclear how often people with PAD are underprescribed these drugs, which characteristics predict clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications, and whether underprescription and non-adherence are associated with adverse health and health system outcomes.Methods and analysisWe will search MEDLINE, EMBASE and Evidence-Based Medicine Reviews from 2006 onwards. Two investigators will independently review abstracts and full-text studies. We will include studies that enrolled adults and reported the incidence and/or prevalence of clinician underprescription of or patient non-adherence to guideline-recommended cardiovascular medications among people with PAD; adjusted risk factors for underprescription of/non-adherence to these medications; and adjusted associations between underprescription/non-adherence to these medications and outcomes. Outcomes will include mortality, major adverse cardiac and limb events (including revascularisation procedures and amputations), other reported morbidities, healthcare resource use and costs. Two investigators will independently extract data and evaluate study risk of bias. We will calculate summary estimates of the incidence and prevalence of clinician underprescription/patient non-adherence across studies. We will also conduct subgroup meta-analyses and meta-regression to determine if estimates vary by country, characteristics of the patients and treating clinicians, population-based versus non-population-based design, and study risks of bias. Finally, we will calculate pooled adjusted risk factors for underprescription/non-adherence and adjusted associations between underprescription/non-adherence and outcomes. We will use Grading of Recommendations, Assessment, Development and Evaluation to determine estimate certainty.Ethics and disseminationEthics approval is not required as we are studying published data. This systematic review will synthesise existing evidence regarding clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications in adults with PAD. Results will be used to identify evidence-care gaps and inform where interventions may be required to improve clinician prescribing and patient adherence to prescribed medications.PROSPERO registration numberCRD42022362801.

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

Cited by 131 publications

References 440 publications

Superior mesenteric artery thrombosis managed percutaneously by timely combining aspiration thrombectomy with angioplasty and stents

Superior mesenteric artery thrombosis managed percutaneously by timely combining aspiration thrombectomy with angioplasty and stents

Waist Training Corset: An Unusual Cause of Acute Lower Limb Ischemia

Evidence for clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications among adults with peripheral artery disease: protocol for a systematic review and meta-analysis

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