Semin intervent Radiol 2018; 35(05): 378-383
DOI: 10.1055/s-0038-1676094
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Multidisciplinary Approach to PAD: Who's on Your Team?

Sabeen Dhand
1   Department of Radiology, Lambert Radiology Medical Group at PIH Health, Whittier, California
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2019 (online)

Abstract

The complexity of peripheral arterial disease (PAD) and its multiorgan involvement requires the utilization of a multispecialty team approach. Members of this team include a vascular specialty (interventional radiology, cardiology, and vascular surgery), podiatry, orthopedic surgery, primary care, infectious disease, endocrinology, plastic surgery, wound care nursing, and dietetics. A team approach has been proven to significantly improve patient outcomes as well as decreasing amputation rates. In order to promote collaboration and avoid duplication of care, the team can be broken down into three main pillars: medical management, wound care, and revascularization. A complete team approach is vital for this population, with an overall goal to treat all manifestations of the disease and prevent further progression and risk of major sequelae of the disease.

 
  • References

  • 1 Walker CM, Bunch FT, Cavros NG, Dippel EJ. Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease. Clin Interv Aging 2015; 10: 1147-1153
  • 2 International Diabetes Federation. IDF Diabetes Atlas, 8th ed. Available at: http://diabetesatlas.org . Accessed September 1, 2018
  • 3 Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293 (02) 217-228
  • 4 Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJ. Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. Diabetes Care 2003; 26 (05) 1435-1438
  • 5 Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation 2011; 124 (01) 17-23
  • 6 Hankey GJ, Jamrozik K, Broadhurst RJ. , et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000; 31 (09) 2080-2086
  • 7 Mustapha JA, Katzen BT, Neville RF. , et al. Disease burden and clinical outcomes following initial diagnosis of critical limb ischemia in the Medicare population. JACC Cardiovasc Interv 2018; 11 (10) 1011-1012
  • 8 Matricali GA, Dereymaeker G, Muls E, Flour M, Mathieu C. Economic aspects of diabetic foot care in a multidisciplinary setting: a review. Diabetes Metab Res Rev 2007; 23 (05) 339-347
  • 9 Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Am Podiatr Med Assoc 2010; 100 (05) 335-341
  • 10 Fitzgerald RH, Mills JL, Joseph W, Armstrong DG. The diabetic rapid response acute foot team: 7 essential skills for targeted limb salvage. Eplasty 2009; 9: e15
  • 11 Frykberg RG. Team approach toward lower extremity amputation prevention in diabetes. J Am Podiatr Med Assoc 1997; 87 (07) 305-312
  • 12 Rogers LC, Andros G, Caporusso J, Harkless LB, Mills Sr JL, Armstrong DG. Toe and flow: essential components and structure of the amputation prevention team. J Am Podiatr Med Assoc 2010; 100 (05) 342-348
  • 13 Sumpio BE, Armstrong DG, Lavery LA, Andros G. ; Society for Vascular Surgery; American Podiatric Medical Association. The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. J Am Podiatr Med Assoc 2010; 100 (04) 309-311
  • 14 Aboyans V, Ricco JB, Bartelink MEL. , et al; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39 (09) 763-816
  • 15 Shishehbor MH, White CJ, Gray BH. , et al. Critical limb ischemia: an expert statement. J Am Coll Cardiol 2016; 68 (18) 2002-2015
  • 16 Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes. World J Diabetes 2015; 6 (07) 961-969
  • 17 Aronow WS. Office management of peripheral arterial disease. Am J Med 2010; 123 (09) 790-792
  • 18 Hirsch AT, Haskal ZJ, Hertzer NR. , et al; American Association for Vascular Surgery/Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)--summary of recommendations. J Vasc Interv Radiol 2006; 17 (09) 1383-1397 , quiz 1398
  • 19 Rooke TW, Hirsch AT, Misra S. , et al; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58 (19) 2020-2045
  • 20 American Diabetes Association. Standards of medical care in diabetes--2006. Diabetes Care 2006; 29 (Suppl 1): S4-S42
  • 21 UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352 (9131): 854-865
  • 22 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285 (19) 2486-2497
  • 23 Nelson EA, O'Meara S, Golder S, Dalton J, Craig D, Iglesias C. ; DASIDU Steering Group. Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med 2006; 23 (04) 348-359
  • 24 Kim PJ, Attinger CE, Evans KK, Steinberg JS. Role of the podiatrist in diabetic limb salvage. J Vasc Surg 2012; 56 (04) 1168-1172
  • 25 Lavery LA, Peters EJ, Armstrong DG. What are the most effective interventions in preventing diabetic foot ulcers?. Int Wound J 2008; 5 (03) 425-433
  • 26 Enoch S, Harding K. Wound bed preparation: the science behind the removal of barriers to healing. Wounds 2003; 15 (07) 213-229
  • 27 Lebrun E, Tomic-Canic M, Kirsner RS. The role of surgical debridement in healing of diabetic foot ulcers. Wound Repair Regen 2010; 18 (05) 433-438
  • 28 Vikatmaa P, Juutilainen V, Kuukasjärvi P, Malmivaara A. Negative pressure wound therapy: a systematic review on effectiveness and safety. Eur J Vasc Endovasc Surg 2008; 36 (04) 438-448
  • 29 Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev 2015; (06) CD004123
  • 30 Neville RF, Kayssi A. Development of a limb-preservation program. Blood Purif 2017; 43 (1-3) 218-225
  • 31 Goodney PP, Travis LL, Nallamothu BK. , et al. Variation in the use of lower extremity vascular procedures for critical limb ischemia. Circ Cardiovasc Qual Outcomes 2012; 5 (01) 94-102
  • 32 Manzi M, Fusaro M, Ceccacci T, Erente G, Dalla Paola L, Brocco E. Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J Cardiovasc Surg (Torino) 2009; 50 (03) 331-337
  • 33 Walker CM, Mustapha J, Zeller T. , et al. Tibiopedal access for crossing of infrainguinal artery occlusions: a prospective multicenter observational study. J Endovasc Ther 2016; 23 (06) 839-846
  • 34 Ballard JL, Mills Sr JL. Surgical management of critical limb ischemia. Tech Vasc Interv Radiol 2005; 8 (04) 169-174
  • 35 Donaldson MC, Whittemore AD, Mannick JA. Further experience with an all-autogenous tissue policy for infrainguinal reconstruction. J Vasc Surg 1993; 18 (01) 41-48
  • 36 Taylor Jr LM, Edwards JM, Porter JM. Present status of reversed vein bypass grafting: five-year results of a modern series. J Vasc Surg 1990; 11 (02) 193-205 , discussion 205–206
  • 37 Farber A, Major K, Wagner WH. , et al. Cryopreserved saphenous vein allografts in infrainguinal revascularization: analysis of 240 grafts. J Vasc Surg 2003; 38 (01) 15-21
  • 38 Goodney PP, Beck AW, Nagle J, Welch HG, Zwolak RM. National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. J Vasc Surg 2009; 50 (01) 54-60
  • 39 Bisdas T, Borowski M, Stavroulakis K, Torsello G. ; CRITISCH Collaborators. Endovascular therapy versus bypass surgery as first-line treatment strategies for critical limb ischemia: results of the interim analysis of the CRITISCH Registry. JACC Cardiovasc Interv 2016; 9 (24) 2557-2565
  • 40 Adam DJ, Beard JD, Cleveland T. , et al; BASIL Trial Participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005; 366 (9501) 1925-1934
  • 41 Farber A, Rosenfield K, Menard M. The BEST-CLI trial: a multidisciplinary effort to assess which therapy is best for patients with critical limb ischemia. Tech Vasc Interv Radiol 2014; 17 (03) 221-224
  • 42 @BEST_CLI. As of today, the #BESTCLI trial has randomized 1433 subjects, only 667 left! #endofsummer #WednesdayMotivation. 2018 August 22, 2018; Available at: https://twitter.com/BEST_CLI/status/1032267109294895106 . Accessed December 5, 2018