Post-Surgical Care for the Individual With PAD:

A Shared Responsibility to Sustain Life and Limb

Post-Surgical Care for the Individual With PAD

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Unless contraindicated, all patientsundergoing revascularization for CLI should be placed on antiplatelet therapy, and this treatment should be continued indefinitely.

Patients who have undergone placement of aortobifemoral bypass grafts should be followed up with periodic evaluations that record any return or progression of ischemic symptoms, the presence of femoral pulses, and ABIs.

Post-Surgical Care for the Individual With PAD: Autogenous Vein Bypass

III IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIIaIIaIIa IIbIIbIIb IIIIIIIII Patients who have undergone placement of a lower extremity bypass with autogenous vein should undergo for at least 2 years periodic examinations that record any return or progression of ischemic symptoms; a physical examination, with concentration on pulse examination of the proximal, graft, and outflow vessels; and Duplex imaging of the entire length of the graft, with measurement of peak systolic velocities and calculation of velocity ratios across all lesions.

Post-Surgical Care for the Individual With PAD: Synthetic Vein Bypass

III IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIIaIIaIIa IIbIIbIIb IIIIIIIII Patients who have undergone placement of a synthetic lower extremity bypass graft should undergo periodic examinations that record any return of ischemic symptoms; a pulse examination of the proximal, graft, and outflow vessels; and assessment of ABIs at rest and after exercise for at least 2 years after implantation.

Post-Surgical Care for the Individual With PAD: Critical Limb Ischemia

Patients with a prior history of CLI or whohave undergone successful treatment for CLI should be evaluated at least twice annually by a vascular specialist owing to the

relatively high incidence of recurrence.

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The PAD Guideline is Intended to Guide Lifelong Primary to Specialty PAD Care

Population at risk:(Age and risk factors)

Establish the PAD diagnosis

Population with symptoms:Improve limb outcomes

Prevent CV ischemic events

MedicalTherapy

EndovascularTherapy

SurgicalTherapy

Integrated care requires a partnership of vascular specialists (vascular medicine,

cardiology, interventional radiology, nursing, podiatry, and others)

•ABI

•TBI

•Duplex US

•MRA

•CTA

•Angiography

Population remains at risk:

Primary care management of legs and life, in

collaboration withvascular specialists

ABI=ankle-brachial index; CTA=computed tomographic angiography; CV=cardiovascular; MRA=magnetic resonance angiography; TBI=toe-brachial index; US= ultrasound.

The PAD Guideline:Diverse Platforms For Diverse Users

The Pocket Guide is:

• A concise summary of the key recommendations & clinical algorithms

• Provides the central “to do” goals for each PAD syndrome

• Is appropriate for clinicians in practice and trainees

• Population at risk is now defined by epidemiologic criteria applied to practice.

• Presentation-specific algorithms will expedite care (e.g., asymptomatic, atypical leg pain, classic claudication, critical limb ischemia, and acute arterial occlusion).

• Use of exercise, pharmacologic, endovascular, and surgical interventions are emplaced in care as defined by evidence.

Intersocietal Guidelines for the Management of PAD:Major Contributions to Improved Care Standards

Public Awarenessof

Peripheral ArterialDisease

Clinician Awarenessof

Peripheral ArterialDisease

The PAD Coalition & PAD Guideline

Individual “at risk” or with PADseeks care (primary care)

Individual “at risk” or with PADreceives vascular care

The Ideal Clinical Synergy:When an Informed Patient Seeks an Informed Clinician

The Peripheral Arterial Disease Coalition

Toward Increased Public Awareness and

Education of PAD in North America

The PAD Coalition

A public, interdisciplinary, not-for-profit Coalition devoted to creating a national PAD public awareness campaign and to

coordinating PAD public and physician education.

www.padcoalition.org

The Peripheral Arterial Disease Coalition

www.PADCoalition.org

Clearinghouse for PAD

educational resources:

• Clinical practice tools

• Slides• Patient

education resources

• Professional meetings

• PAD Coalition news

The Peripheral Arterial Disease Coalition

www.aboutpad.org

“Stay in Circulation:

Take Steps to Learn About

PAD” Campaign Web

Site

• Community Action Toolkit

• Media Resources

• Fact Sheets• Posters• “Patient

Stories” Video• Radio and print

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