Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck, Martin; Earnshaw, J. J.; Acosta, Stefan; Gonçalves, Frederico Bastos; Cochennec, Frédéric; Debus, Eike Sebastian; Hinchliffe, Robert J.; Jongkind, Vincent; Koelemay, M.J.W.; Menyhei, Gábor; Светликов, А. В.; Tshomba, Yamume; Berg, Jos C. van den; Borst, Gert J. de; Chakfé, Nabil; Kakkos, Stavros K.; Končar, Igor; Lindholt, Jes Sanddal; Tulamo, Riikka; Céniga, Melina Vega de; Vermassen, Frank; Boyle, Jonathan R.; Mani, Kevin; Azuma, Nobuyoshi; Choke, Edward Tieng Chek; Cohnert, Tina; Fitridge, Robert; Forbes, Thomas L.; Hamady, Mohamad; Muñoz, Alberto; Müller‐Hülsbeck, Stefan; Rai, Kumud

doi:10.1016/j.ejvs.2019.09.006

Cited by 315 publications

(264 citation statements)

References 291 publications

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“…Traditionally, all patients with arterial thrombosis (due to embolic or in-situ thrombosis) are managed with lifelong anticoagulation. 11 However, this case of in-situ thrombosis is different from the usual aetiologies. Whether this could be treated like provoked DVT's with 3 months anticoagulation or embolic arterial event with lifelong anticoagulation is uncertain.…”

Section: Discussionmentioning

confidence: 70%

Bilateral Acute Lower Limb Ischemia Secondary to COVID-19

Veerasuri¹,

Kulkarni

Wilson

et al. 2020

Vasc Endovascular Surg

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COVID-19 has to date affected over 5 million people worldwide and caused in excess of 300000 deaths. One of the principal finding is that of a thrombotic tendency within the lungs leading to high mortality. There have been increasing number of reports of peripheral arterial thrombosis as well. Most cases of arterial thrombosis is noted in patient in intensive care setting. Here-in we report a case of acute bilateral lower limb arterial thrombosis in a patient recovering at home with mild COVID-19 symptoms, highlighting that patients with milder symptoms may also suffer from prothrombotic state resulting in acute arterial occlusions. Arterial thrombosis should be suspected in these patients despite the absence of predisposing factors.

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Section: Discussionmentioning

confidence: 70%

Bilateral Acute Lower Limb Ischemia Secondary to COVID-19

Veerasuri¹,

Kulkarni

Wilson

et al. 2020

Vasc Endovascular Surg

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“…4 There are several indications for LEA, including an injured or malperfused limb not amenable to salvage (or where attempts at salvage have failed), and an injured limb wherein mortality is a risk from infection, or malignancy. 5,6 In developed countries, LEA results primarily from failure of limb conserving interventions in the management of diabetes and/or PAOD. 7 The present study group has previously used data obtained from the Global Burden of Disease (GBD) Study to demonstrate decreasing trends in PAOD incidence across European Union (EU) 15þ countries, 8 a group of countries that have previously been demonstrated to be comparable in terms of their health expenditure.…”

Section: Introductionmentioning

confidence: 99%

Editor's Choice – Trends in Lower Extremity Amputation Incidence in European Union 15+ Countries 1990–2017

Hughes

Goodall

Salciccioli

et al. 2020

European Journal of Vascular and Endovascular Surgery

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This is an observational analysis of lower limb amputation incidence in European Union (EU) 15þ countries between 1990 and 2017, using data obtained from the Global Burden of Disease (GBD) Study 2017. The hypothesis was that reducing incidence trends would be identified, given previous work from the present study group using the GBD Study, which identified reducing incidence of peripheral arterial disease over the same time period in EU15þ countries. However, the present study identifies variable trends in lower limb amputation incidence across EU15þ countries between 1990 and 2017. The potential contributors to the observed results are discussed. Objective: Lower extremity amputation (LEA) carries significant mortality, morbidity, and health economic burden. In the Western world, it most commonly results from complications of peripheral arterial occlusive disease (PAOD) or diabetic foot disease. The incidence of PAOD has declined in Europe, the United States, and parts of Australasia. The present study aimed to assess trends in LEA incidence in European Union (EU15þ) countries for the years 1990e2017. Methods: This was an observational study using data obtained from the 2017 Global Burden of Disease (GBD) Study. Age standardised incidence rates (ASIRs) for LEA (stratified into toe amputation, and LEA proximal to toes) were extracted from the GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool) for EU15þ countries for each of the years 1990e2017. Trends were analysed using Joinpoint regression analysis. Results: Between 1990 and 2017, variable trends in the incidence of LEA were observed in EU15þ countries. For LEAs proximal to toes, increasing trends were observed in six of 19 countries and decreasing trends in nine of 19 countries, with four countries showing varying trends between sexes. For toe amputation, increasing trends were observed in eight of 19 countries and decreasing trends in eight of 19 countries for both sexes, with three countries showing varying trends between sexes. Australia had the highest ASIRs for both sexes in all LEAs at all time points, with steadily increasing trends. The USA observed the greatest reduction in all LEAs in both sexes over the time period analysed (LEAs proximal to toes: female patients À22.93%, male patients À29.76%; toe amputation: female patients À29.93%, male patients À32.67%). The greatest overall increase in incidence was observed in Australia. Conclusion: Variable trends in LEA incidence were observed across EU15þ countries. These trends do not reflect previously observed reductions in incidence of PAOD over the same time period.

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“…The current European Society for Vascular Surgery (ESVS) 2020 ALI management guidelines, published in this issue of the Journal, offer up to date guidance on therapeutic decision making. 1 However, they also highlight that both the mix of the underlying causes of ALI and the limited amount of high quality evidence remain major limitations in defining universal treatment algorithms. The natural question that arises from this background is: Where will we go to in the treatment of ALI in the future?…”

mentioning

confidence: 99%

“…Hence available outcome data should be evaluated within distinct patient subgroups; and consensus regarding patient classification and risk stratification should be reached first. 1 As the guidelines rightly point out, no biomarkers yet exist to assist with classification and outcome prediction. 1 Use of artificial intelligence with deep learning could be an alternative approach if available data were amalgamated.…”

mentioning

confidence: 99%