Neville RF, Kayssi A, et al.
Blood purification. Date of publication 2017 Jan 1;volume 43(1-3):218-225.
1. Blood Purif. 2017;43(1-3):218-225. doi: 10.1159/000452746. Epub 2017 Jan 24.
Development of a Limb-Preservation Program.
Neville RF(1), Kayssi A.
Author information:
(1)Inova Heart and Vascular Institute, Division of Vascular Surgery, Department
of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.
In the global scenario, as the prevalence of renal failure and diabetes
increases, healing and limb preservation assume increasing clinical importance
for patients and healthcare systems. Unfortunately, there continues to be
variation in the care delivered to patients at risk of losing a limb based on
geography, race, socioeconomic status, and insurance status. There are also a
variety of therapeutic approaches to patients with limb-threatening ischemia; 25%
undergo primary amputation, 25% undergo medical therapy, and only 50% undergo any
attempt at revascularization. Nearly 50% of patients undergoing major amputation
have not had a simple diagnostic arteriogram to assess the possibility of limb
preservation. The Society of Vascular Surgery and the American Podiatric Medical
Association have recognized the benefits of a multidisciplinary approach to limb
preservation. Benefits to the patient include rapid assessment, improved healing,
and enhanced revascularization. Advantages for the providers include the ability
to efficiently manage complex patients with help from the appropriate
specialties, an increase in referrals, enhanced identity of the institution, and
clinical research and trials. Such a program requires the coordinated effort of
physicians, nurses, allied health professionals, and administrators dedicated to
the preservation of functional limbs. Beneficial components include identifiable
space, a vascular laboratory, hyperbaric oxygen therapy, and protocol-driven care
involving diagnostic and therapeutic modalities such as endovascular
revascularization, open bypass, and soft tissue reconstruction. Prosthetic
expertise is also important to maintain function in those patients for whom
amputation is appropriate. But, the key to a program is cooperation and
communication among the participants who have a passion for limb preservation.
Video Journal Club 'Cappuccino with Claudio Ronco' at
http://www.karger.com/?doi=452746.
© 2017 S. Karger AG, Basel.
DOI: 10.1159/000452746
PMID: 28114132 [Indexed for MEDLINE]
