Description
Book SynopsisThis book is a comprehensive guide to the essentials of arterial, venous, wound care, and multidisciplinary approaches to prevent major amputation and manage patients with critical limb threatening ischemia (CLTI). Limb preservation has become increasingly prioritized as endovascular techniques, equipment, understanding of multidisciplinary wound care, and other medical treatments have rapidly evolved. Quite often, these patients have CLTI, which is a primarily chronic arterial disease that carries a higher mortality rate than most cancers and cardiovascular diseases. Additionally, complex venous issues contribute to patients losing their limbs, causing significant morbidity to patients and immense cost to the medical system. Many of these patients have diabetes, kidney problems, and hypertension. Due to the advances in the treatment of CLTI and complex venous diseases, medical professionals have been able to decrease major amputations, which cause the higher mortality rate described above. The knowledge of all the approaches, techniques, and management of these patients, however, has been slow to be disseminated.
Acting as a structured journey to all aspects of limb preservation, this book begins by covering the basics of understanding wound care patients. This involves beginning wound care management and properly diagnosing the potential underlying processes with non-invasive imaging. From here, clinical pearls and detailed guidance on considering arterial, venous, and lymphatic therapies are covered. Chapters then move into arterial and venous treatment algorithms, from unique to complex approaches, technique tips and tricks, infection and complication management, and future options. Understanding some of the newer approaches such as deep vein arterialization and hybrid surgical approaches is integral in the discussion. Finally, authors cover evaluating the wound post-procedure and long-term, deciding when re-intervention/surgery or amputation (and which type) is needed, and how to tackle the medication management of these complex patients (such as antiplatelets, anticoagulation, diabetes, and nutrition). Chapters are written by a multidisciplinary group of experts, all with an eye towards limb preservation.
This is an ideal guide for endovascular specialists, surgeons, podiatrists, infectious disease specialists, and endocrinologists to be able to successfully increase the likeliness of limb preservation for their patients with CLTI and related conditions.
Table of ContentsI. Seeing a patient with a wound
a. Mastering the wound care physical exam: Tips
b. How to classify the wound
i. When should I consider Venous or Mixed wounds
c. Basics of debridement
d. Basics of dressings and when to make a change
e. When should I culture?
f. When should I biopsy?
g. How do I biopsy a wound?
h. When should I not debride?
i. What are Calciphylaxis wounds?
II. Determining appropriate workup
a. Non-invasive arterial and venous studies
b. When to get ABI vs Duplex vs Cross sectional imaging
i. Should I order an ABI, Toe Pressures or a Duplex?
ii. Why do I need cross sectional imaging?
iii. When should I consider CTV/MRV?
c. Interpreting the ABI, TBI, Toe Pressures: Know the pitfalls
d. Interpreting the CT and MRI: Know the limitations
III. Beginning and Managing Underlying Co-morbidities
a. Basic PAD medications
b. When should I start DAPT therapy?
i. DAPT made simple
c. When should I consider Anticoagulation?
d. When should not start compression therapy?
e. Lymphedema
i. Clinics, Pumps and Surgeries
IV. Infectious Disease evaluation and management
a. When should I call ID?
b. Is there osteomyelitis (OM)?
i. What imaging do I order for OM?
c. When to start Antibiotics?
d. When is source control emergent?
e. How to prevent infection in wounds
V. Arterial Revascularization
a. Aorto-iliac
i. Stent choice
ii. CERAB
b. When to choose alternative access
i. Pedal Access
1. Tips
ii. Fem-Pop access and closure
iii. Radial/Brachial access and closure
1. Device selection for upper extremity access
c. CO2 tips and tricks
d. Heavy Calcium
i. When should I consider IVL?
ii. When to consider Laser?
e. Hidden thrombus
i. Atherectomy vs Mechanical thrombectomy
f. Distal emboli management
g. Blue toe syndrome management
h. Popliteal Aneurysms
i. Stenting vs Surgery: Why and When
i. Common Femoral Artery
i. Endo vs Surgical
ii. When and How I choose to intervene
1. Tips/Tricks
iii. When I prefer surgery
1. What patient can’t have a cutdown?
j. Distal surgical bypass options
k. Re-do a Re-do or Endo now?
l. IVUS based atherectomy selection
m. EVUS benefits
n. EPD use
o. Thrombolysis as a last shot
p. What’s my endpoint on angio?
q. Deep Vein Arterialization (DvA)
i. When to consider DvA?
1. Workup
2. What to tell the patient/family/referrer
ii. When to never DvA?
iii. What I wish I knew about DvA
VI. Venous Interventions
a. Superficial venous disease
i. When and how to treat
1. EVLT
2. Sclerotherapy
3. Peri-wound Varices Management
4. Tarsal Tunnel Syndrome
b. Deep Vein disease
i. When to treat deep veins
ii. When to stent Iliacs
iii. Stenting below the inguinal ligament
1. Tips and tricks
c. Ilio-caval reconstruction
i. IVC Filter management
ii. Stenting across filters
iii. Sharp Recanalization
d. Surgical Intervention
e. Percutaneous Bypass
f. Compression Therapy
VII. Post Procedure Management
a. Follow-up planning
b. Monitoring the wound
VIII. When is the wound Closed?
a. Should I re-intervene?
IX. Long term Imaging
a. What modality to follow arterial
i. When to change
b. What modality to follow venous
i. When to change
X. Long term Medical Management
a. Arterial
i. When to stop DAPT
ii. When to change the meds
b. Venous
i. Choosing the right AC
ii. When to change
iii. When to stop
XI. Closing
