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In a publication in the Lancet by the Global Burden of Disease Collaborators, peripheral artery disease (PAD) was noted to be a major public health concern due to its high and rising prevalence. Intermittent claudication (IC) is the most common symptomatic manifestation of PAD, causing significant disability and reductions in health-related quality of life. While, at the global level, there is concern for gross under-treatment of PAD, here in the US, there has been growing concern for over-treatment of IC. It is clear that IC is a topic that warrants a dedicated, thorough, evidence-based resource that can help vascular specialists gain a comprehensive understanding of IC and how to best approach and engage patients in their care.
This book reviews the current literature and clinical practices related to a patient-centered approach to claudication, from the anatomy, physiology and epidemiology related to IC to diagnosis, risk factors and management techniques, including pharmacology, exercise therapy, and open and endovascular revascularization. There are sections dedicated to outcome disparities, the psychological impact of IC, patient preference science and cost effectiveness. There is also a patient-facing brochure and educational poster that can be accessed and downloaded freely. The content is geared toward a range of providers, from practicing vascular specialists and primary care providers to those in vascular training programs. Future directions for treatment and research, as well as an assessment of unmet needs, round out the presentation.
Sommario
A Framework for Physicians and Patients with Claudication: Toward a Patient-Centered Approach.- Anatomy, Physiology, and Pathophysiology of Claudication.- National and International Trends in Prevalence and Incidence of Intermittent Claudication Since 1950.- Making the Diagnosis of Vasculogenic Claudication.- The Natural History of the Limbs in Patients with Intermittent Claudication.- Contemporary Health Disparities in the Diagnosis and Management of Claudication.- Risk Factors for Claudication and Management to Modify Them.- Defining and Choosing Outcome Measures for Managing Claudication.- Pharmacologic Therapy to Improve Functional and Limb Outcomes.- Smoking Cessation in the Management of Claudication: Why and How.- Behavioral and Mental Health Considerations for Patients Experiencing Vasculogenic Claudication.- Exercise Therapy for Peripheral Artery Disease: Mechanisms, Outcomes, and Optimal Methods.- Aortoiliac Revascularization for Claudication: Evidence, Outcomes, and Patient Selection.- Revascularization: Common Femoral and Profunda Femoris Arteries Evidence, Techniques, and Patient Selection.- Revascularization: Infrainguinal Evidence, Techniques, and Patient Selection.- Revascularization for Claudication in the Setting of Multi-level and/or Bilateral Disease: How Many Levels to Treat and How.- Risks of Revascularization: The So-Called Treatment Trap.- A Brief Primer on Shared Decision-Making and Applications to Claudication.- Non-traditional and Emerging Treatments for Intermittent Claudication.- Differences between Published Guidelines and Consensus Statements on the Management of Claudication: Society for Vascular Surgery, American College of Cardiology/American Heart Association, and European Society for Vascular Surgery.- Cost-Effectiveness of Claudication Treatment.- Unmet Needs and New Horizons in Treating Patients with Claudication.
Info autore
William P. Robinson III, MD, FACS, DFSVS, Division of Vascular Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
Jessica P. Simons, MD, MPH, DFSVS, Division of Vascular and Endovascular Surgery, Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA.
