View source for Management of acute limb ischemia in lower extremity peripheral arterial disease

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{{Peripheral arterial disease}}
{{CMG}} {{AE}} {{USAMA}}

=2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease<ref name="pmid27840333">{{cite journal| author=Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE et al.| title=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. | journal=Circulation | year= 2016 | volume=  | issue=  | pages=  | pmid=27840333 | doi=10.1161/CIR.0000000000000471 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27840333  }} </ref>=

==Recommendations for Management of Acute Limb Ischemia (ALI)==
===Recommendations for Clinical Presentation of ALI:===
{|class="wikitable" 
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| 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.''' Patients with ALI should be emergently evaluated by a clinician with sufficient experience to assess limb viability and implement appropriate therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with suspected ALI, initial clinical evaluation should rapidly assess limb viability and potential for salvage and does not require imaging. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
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===Recommendation for Medical Therapy of ALI:===

{|class="wikitable" style="width:82%"
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| 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.''' In patients with ALI, systemic anticoagulation with [[heparin]] should be administered unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki>
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===Recommendations for Revascularization for ALI:===
{|class="wikitable" 
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| 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.''' In patients with ALI, the [[revascularization]] strategy should be determined by local resources and patient factors (e.g., etiology and degree of [[Ischemia|ischemia)]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Catheter-based thrombolysis is effective for patients with ALI and a salvageable limb. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.'''[[Amputation]] should be performed as the first procedure in patients with a non salvageable limb. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''Patients with ALI should be monitored and treated (e.g., [[fasciotomy]]) for [[compartment syndrome]] after [[revascularization]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
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{|class="wikitable" 
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| 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.''' In patients with ALI with a salvageable limb, percutaneous mechanical [[thrombectomy]] can be useful as adjunctive therapy to [[Thrombolysis|thrombolysis.]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki>
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.'''In patients with ALI due to embolism and with a salvageable limb, surgical thromboembolectomy can be effective.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
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{|class="wikitable" 
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| 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 ultrasound-accelerated catheter-based [[thrombolysis]] for patients with ALI with a salvageable limb is unknown. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki>
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===Recommendations for Diagnostic Evaluation of the Cause of ALI:===
{|class="wikitable" style="width:82%"
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| 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.''' In the patient with ALI, a comprehensive history should be obtained to determine the cause of [[thrombosis]] and/or [[embolization]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki>
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{|class="wikitable" style="width:82%"
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| 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.''' In the patient with a history of ALI, testing for a cardiovascular cause of [[thromboembolism]] can be useful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki>
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===References===
{{Reflist|1}}