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===Recommendation for Revascularization for CLI:=== | |||
{|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 CLI, [[revascularization]] should be performed when possible to minimize tissue loss.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''An evaluation for [[revascularization]] options should be performed by an interdisciplinary care team before amputation in the patient with CLI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]])''<nowiki>"</nowiki> | |||
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====Recommendations for Endovascular Revascularization for CLI:==== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Endovascular procedures are recommended to establish in-line blood flow to the foot in patients with nonhealing wounds or [[gangrene]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<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]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' A staged approach to endovascular procedures is reasonable in patients with ischemic rest pain. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Evaluation of lesion characteristics can be useful in selecting the endovascular approach for CLI.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<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]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''Use of angiosome-directed endovascular therapy may be reasonable for patients with CLI and nonhealing wounds or [[gangrene]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | |||
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====Recommendations for Surgical Revascularization for CLI:==== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' When surgery is performed for CLI, bypass to the popliteal or infrapopliteal arteries (i.e., tibial, pedal) should be constructed with suitable autogenous vein.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Surgical procedures are recommended to establish in-line blood flow to the foot in patients with nonhealing wounds or [[gangrene]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | |||
|- | |||
|} | |||
{|class="wikitable" style="width:82%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with CLI for whom endovascular revascularization has failed and a suitable autogenous vein is not available, prosthetic material can be effective for bypass to the below-knee popliteal and tibial arteries. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' A staged approach to surgical procedures is reasonable in patients with ischemic rest pain. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | |||
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|} | |||
===Recommendation for Wound Healing Therapy:=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An interdisciplinary care team should evaluate and provide comprehensive care for patients with CLI and tissue loss to achieve complete wound healing and a functional foot''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In patients with CLI, wound care after [[revascularization]] should be performed with the goal of complete wound healing''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | |||
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|} | |||
{|class="wikitable" style="width:82%" | |||
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| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | |||
|- | |||
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Prostanoids are not indicated in patients with CLI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])''<nowiki>"</nowiki> | |||
|- | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients with CLI, intermittent pneumatic compression (arterial pump) devices may be considered to augment wound healing and/or ameliorate severe ischemic rest pain. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' patients with CLI, the effectiveness of [[hyperbaric oxygen therapy]] for wound healing is unknown. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])''<nowiki>"</nowiki> | |||
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|} | |||
===References=== | |||
{{Reflist|1}} | |||
Revision as of 16:57, 30 November 2017
Recommendation for Revascularization for CLI:
| Class I |
| "1.In patients with CLI, revascularization should be performed when possible to minimize tissue loss.(Level of Evidence: B-NR)" |
| "2.An evaluation for revascularization options should be performed by an interdisciplinary care team before amputation in the patient with CLI.(Level of Evidence: C-EO)" |
Recommendations for Endovascular Revascularization for CLI:
| Class I |
| "1.Endovascular procedures are recommended to establish in-line blood flow to the foot in patients with nonhealing wounds or gangrene.(Level of Evidence: B-R)" |
| Class IIa |
| "1. A staged approach to endovascular procedures is reasonable in patients with ischemic rest pain. (Level of Evidence: C-LD)" |
| "2. Evaluation of lesion characteristics can be useful in selecting the endovascular approach for CLI.(Level of Evidence: B-R)" |
| Class IIb |
| "1.Use of angiosome-directed endovascular therapy may be reasonable for patients with CLI and nonhealing wounds or gangrene. (Level of Evidence: B-NR)" |
Recommendations for Surgical Revascularization for CLI:
| Class I |
| "1. When surgery is performed for CLI, bypass to the popliteal or infrapopliteal arteries (i.e., tibial, pedal) should be constructed with suitable autogenous vein.(Level of Evidence: A)" |
| "2. Surgical procedures are recommended to establish in-line blood flow to the foot in patients with nonhealing wounds or gangrene. (Level of Evidence: C-LD)" |
| Class IIa |
| "1. In patients with CLI for whom endovascular revascularization has failed and a suitable autogenous vein is not available, prosthetic material can be effective for bypass to the below-knee popliteal and tibial arteries. (Level of Evidence: B-NR)" |
| "2. A staged approach to surgical procedures is reasonable in patients with ischemic rest pain. (Level of Evidence: C-LD)" |
Recommendation for Wound Healing Therapy:
| Class I |
| "1. An interdisciplinary care team should evaluate and provide comprehensive care for patients with CLI and tissue loss to achieve complete wound healing and a functional foot(Level of Evidence: B-NR)" |
| "2. In patients with CLI, wound care after revascularization should be performed with the goal of complete wound healing(Level of Evidence: C-LD)" |
| Class III (No Benefit) |
| "1. Prostanoids are not indicated in patients with CLI. (Level of Evidence: B-R)" |
| Class IIb |
| "1. In patients with CLI, intermittent pneumatic compression (arterial pump) devices may be considered to augment wound healing and/or ameliorate severe ischemic rest pain. (Level of Evidence: B-NR)" |
| "2. patients with CLI, the effectiveness of hyperbaric oxygen therapy for wound healing is unknown. (Level of Evidence: C-LD)" |