Lower Limb Peripheral Arterial Disease (Clinical Guideline 147): A Guideline Summary

Carthy, Elliott

doi:10.1016/s2049-0801(13)70024-4

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…The fact that patients delayed seeking medical help until there was significant walking impairment and restrictions in many aspects of their life[ 16 , 17 ], could be indicative of a lack of understanding of symptom/disease pathology in this population[ 34 ]. To reduce the risk of complications such as critical limb ischaemia, the need for limb amputation or adverse events (cardiovascular disease morbidity/mortality) prompt diagnosis of PAD is critical[ 35 ]. As seen in the included studies[ 10 , 18 , 23 ], and elsewhere in the literature[ 34 , 35 ], lack of understanding of the disease pathology is common throughout PAD disease trajectory even among patients who have undergone intervention or SEP.…”

Section: Discussionmentioning

confidence: 99%

“…To reduce the risk of complications such as critical limb ischaemia, the need for limb amputation or adverse events (cardiovascular disease morbidity/mortality) prompt diagnosis of PAD is critical[ 35 ]. As seen in the included studies[ 10 , 18 , 23 ], and elsewhere in the literature[ 34 , 35 ], lack of understanding of the disease pathology is common throughout PAD disease trajectory even among patients who have undergone intervention or SEP. In addition to aggressively pursuing the NICE recommendation to provide information on the cause, severity, associated risks, risk factors, pain management, treatment options, and psychosocial support for persons already diagnosed with PAD[ 36 ], a wider campaign may help raise general awareness of PAD and atherosclerosis to improve recognition of early symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

et al. 2018

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BackgroundPeripheral arterial disease (PAD) has a significant negative impact on the quality of life of individuals. Understanding the experiences of people living with PAD will be useful in developing comprehensive patient-centred secondary prevention therapies for this population.AimThe aim of this study is to identify first-hand accounts of patients’ experiences of living with PAD.MethodsSix databases (CINALH, PsyclNFO, MEDLINE, AMED, EMBASE, Social citation index/Science citation index via Web of Science (WOS)) and reference lists of identified studies were searched until September 2017 (updated February 2018). Qualitative studies reporting patients’ account of living with PAD were eligible for inclusion. A framework thematic synthesis was implemented.ResultsFourteen studies with 360 participants were included. Pain and walking limitation were recurrent among the varied symptom descriptions. Patients’ ignorance and trivialisation of symptoms contributed to delays in diagnosis. Inadequate engagement in disease understanding and treatment decisions meant patients had poor attitudes towards walking treatments and unrealistic expectations about surgery. Depending on symptom progression, patients battle with walking impairment, powerlessness, and loss of independence which were a source of burden to them. Lack of disease understanding is central through patients’ journey with PAD and, although they subsequently began adaptation to long term living with PAD, many worried about their future.ConclusionsDisease understanding is vital across the illness trajectory in patients with PAD. Although certain experiences are common throughout patient journey, some might be unique to a particular stage (e.g. unrealistic expectation about surgery, or rationale of walking in spite of pain in a supervised exercise program). Given that PAD is an overarching construct ranging from the mildest form of intermittent claudication to severe critical limb ischemia with ulceration and gangrene, consideration of important patient constructs specific to each stage of the disease may enhance treatment success. Systematic review registration CRD42017070417.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

et al. 2018

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“… 19 The National Institute For Health and Clinical Excellence guidelines for lower limb peripheral arterial disease state that there is substantial evidence establishing benefits for lowering cholesterol drugs for patients with PAD, and the use of limb-saving procedure is also recommended. 20 The benefits of cholesterol-lowering drugs have shown a significant reduction in the risk of major amputation. 21 22 …”

Section: Introductionmentioning

confidence: 99%

Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation

et al. 2017

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ObjectivesPatients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about the progression of diseases related to lower extremity amputations during the years preceding the amputation.DesignA retrospective population-based national registry study.SettingThe study includes data on demographics, diagnoses, surgery, medications and healthcare services from five national registries. Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services.ParticipantsAn unselected cohort of patients (≥50 years; n=2883) subjected to a primary non-traumatic lower extremity amputation in 2010 or 2011 in Denmark.ResultsThe prevalence of atherosclerosis, hypertension and diabetes was 70%, 53% and 49%, respectively. Among patients with atherosclerosis, 42% had not received cholesterol-lowering treatment even though 87% had visited their general practitioner within the last year prior to amputation. Further, 16% were diagnosed with diabetes at the time of the amputation. The prevalence of cardiovascular diseases increased from 22% to 70%, atherosclerosis from 5% to 53% and diabetes from 17% to 35% over the 14 years preceding major amputation. Of all patients, 64% had been in contact with the hospital or outpatient clinics within the last 3 years, and 29% received a prescription of opioids 3 years prior to the amputation.ConclusionAmong patients with non-traumatic lower extremity amputation, one-third live with undiagnosed and untreated atherosclerosis and one-sixth suffer from undiagnosed diabetes despite continuous contacts to general practitioner and the hospital. This study emphasises a need for enhanced focus, among both hospital clinicians and general practitioners, on the early identification of atherosclerosis and diabetes.

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“…Amputation inevitably is the only option when ischemic tissue is subjected to unmanageable infections, and when the ischemic rest pain or tissue loss cannot be restored by any surgical or nonsurgical approaches (Carthy, 2013). Depending on the level of amputation, two types of amputations are performed: minor amputation and major amputation.…”

Section: Amputationmentioning

confidence: 99%

Critical limb ischemia: Current and novel therapeutic strategies

Hassanshahi

Khabbazi

Peymanfar

et al. 2019

Journal Cellular Physiology

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Critical limb ischemia (CLI) is the advanced stage of peripheral artery disease spectrum and is defined by limb pain or impending limb loss because of compromised blood flow to the affected extremity. Current conventional therapies for CLI include amputation, bypass surgery, endovascular therapy, and pharmacological approaches. Although these conventional therapeutic strategies still remain as the mainstay of treatments for CLI, novel and promising therapeutic approaches such as proangiogenic gene/protein therapies and stem cell‐based therapies have emerged to overcome, at least partially, the limitations and disadvantages of current conventional therapeutic approaches. Such novel CLI treatment options may become even more effective when other complementary approaches such as utilizing proper bioscaffolds are used to increase the survival and engraftment of delivered genes and stem cells. Therefore, herein, we address the benefits and disadvantages of current therapeutic strategies for CLI treatment and summarize the novel and promising therapeutic approaches for CLI treatment. Our analyses also suggest that these novel CLI therapeutic strategies show considerable advantages to be used when current conventional methods have failed for CLI treatment.

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Lower Limb Peripheral Arterial Disease (Clinical Guideline 147): A Guideline Summary

Cited by 10 publications

References 15 publications

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

Progression of disease preceding lower extremity amputation in Denmark: a longitudinal registry study of diagnoses, use of medication and healthcare services 14 years prior to amputation

Critical limb ischemia: Current and novel therapeutic strategies

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