Revascularization for claudication in lower extremity peripheral arterial disease: Difference between revisions
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Revascularization is a reasonable treatment option for the patient with lifestyle limiting claudication with an inadequate response to GDMT.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Revascularization]] is a reasonable treatment option for the patient with lifestyle limiting claudication with an inadequate response to [[GDMT]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Endovascular procedures are effective as a revascularization option for patients with lifestyle-limiting claudication and hemodynamically significant aortoiliac occlusive disease.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Endovascular procedures are effective as a [[revascularization]] option for patients with lifestyle-limiting claudication and hemodynamically significant [[aortoiliac occlusive disease]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm) | | colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm) | ||
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| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Endovascular procedures should not be performed in patients with PAD solely to prevent progression to CLI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | | bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Endovascular procedures should not be performed in patients with [[PAD]] solely to prevent progression to CLI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | ||
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''The usefulness of endovascular procedures as a revascularization option for patients with claudication due to isolated infrapopliteal artery disease is unknown.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''The usefulness of endovascular procedures as a [[revascularization]] option for patients with [[claudication]] due to isolated infrapopliteal artery disease is unknown.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' When surgical revascularization is performed, bypass to the popliteal artery with autogenous vein is recommended in preference to prosthetic graft material.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' When surgical [[Revascularization surgery|revascularization]] is performed, bypass to the popliteal artery with autogenous vein is recommended in preference to [[prosthetic]] graft material.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm) | | colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm) | ||
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| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Femoral-tibial artery bypasses with prosthetic graft material should not be used for the treatment of claudication.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<nowiki>"</nowiki> | | bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Femoral-tibial artery bypasses with prosthetic graft material should not be used for the treatment of [[claudication]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Surgical procedures should not be performed in patients with PAD solely to prevent progression to CLI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | | bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Surgical procedures should not be performed in patients with PAD solely to prevent progression to CLI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Surgical procedures are reasonable as a revascularization option for patients with lifestyle-limiting claudication with inadequate response to GDMT, acceptable perioperative risk, and technical factors suggesting advantages over endovascular procedures.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Surgical procedures are reasonable as a [[revascularization]] option for patients with lifestyle-limiting claudication with inadequate response to [[GDMT]], acceptable [[Perioperative risk evaluation|perioperative risk]], and technical factors suggesting advantages over endovascular procedures.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | ||
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Latest revision as of 20:52, 22 November 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease[1]
Recommendation for Revascularization for Claudication in the Patient with PAD
Class IIa |
"1. Revascularization is a reasonable treatment option for the patient with lifestyle limiting claudication with an inadequate response to GDMT.(Level of Evidence: A)" |
Recommendations for Endovascular Revascularization for Claudication:
Class I |
"1. Endovascular procedures are effective as a revascularization option for patients with lifestyle-limiting claudication and hemodynamically significant aortoiliac occlusive disease.(Level of Evidence: A)" |
Class III (Harm) |
"1. Endovascular procedures should not be performed in patients with PAD solely to prevent progression to CLI.(Level of Evidence: B-NR)" |
Class IIa |
"1.Endovascular procedures are reasonable as a revascularization option for patients with lifestyle-limiting claudication and hemodynamically significant femoropopliteal disease.(Level of Evidence: B-R)" |
Class IIb |
"1.The usefulness of endovascular procedures as a revascularization option for patients with claudication due to isolated infrapopliteal artery disease is unknown.(Level of Evidence: C-LD)" |
Recommendations for Surgical Revascularization for Claudication:
Class I |
"1. When surgical revascularization is performed, bypass to the popliteal artery with autogenous vein is recommended in preference to prosthetic graft material.(Level of Evidence: A)" |
Class III (Harm) |
"1. Femoral-tibial artery bypasses with prosthetic graft material should not be used for the treatment of claudication.(Level of Evidence: B-R)" |
"2. Surgical procedures should not be performed in patients with PAD solely to prevent progression to CLI.(Level of Evidence: B-NR)" |
Class IIa |
"1.Surgical procedures are reasonable as a revascularization option for patients with lifestyle-limiting claudication with inadequate response to GDMT, acceptable perioperative risk, and technical factors suggesting advantages over endovascular procedures.(Level of Evidence: B-NR)" |
References
- ↑ Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE; et al. (2016). "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000471. PMID 27840333.