| Claudication |
Fatigue, discomfort, cramping, or pain of
vascular origin in the muscles of the lower extremities that is
consistently induced by exercise and consistently relieved by rest
(within 10 min). |
| Acute limb ischemia (ALI) |
Acute (<2 wk), severe hypoperfusion of
the limb characterized by these features: pain, pallor, pulselessness,
poikilothermia (cold), paresthesias, and paralysis. One of these categories of ALI is assigned (Section 10):
Viable—Limb is not immediately
threatened; no sensory loss; no muscle weakness;
audible arterial and venous Doppler. Threatened—Mild-to-moderate sensory or
motor loss; inaudible arterial Doppler; audible
venous Doppler; may be further divided into IIa
(marginally threatened) or IIb (immediately
threatened). Irreversible—Major tissue loss or
permanent nerve damage inevitable; profound
sensory loss, anesthetic; profound muscle weakness
or paralysis (rigor); inaudible arterial and
venous Doppler. 33,34
|
| Tissue loss |
Type of tissue loss:
Minor—nonhealing ulcer, focal gangrene with diffuse
pedal ischemia. Major—extending above transmetatarsal level;
functional foot no longer salvageable.33
|
| Critical limb ischemia (CLI) |
A condition characterized by chronic
(≥2 wk) ischemic rest pain, nonhealing wound/ulcers, or gangrene
in 1 or both legs attributable to objectively proven arterial occlusive
disease. The diagnosis of CLI is a constellation of both symptoms and
signs. Arterial disease can be proved objectively with ABI,
TBI, TcPO2, or skin perfusion pressure.
Supplementary parameters, such as absolute ankle and toe
pressures and pulse volume recordings, may also be used to
assess for significant arterial occlusive disease. However,
a very low ABI or TBI does not necessarily mean the patient
has CLI. The term CLI implies chronicity and is to be
distinguished from ALI.35
|
| In-line blood flow |
Direct arterial flow to the foot, excluding
collaterals. |
| Functional status |
Patient's ability to perform normal
daily activities required to meet basic needs, fulfill usual roles, and
maintain health and well-being. Walking ability is a component of
functional status. |
| Nonviable limb |
Condition of extremity (or portion of
extremity) in which loss of motor function, neurological function, and
tissue integrity cannot be restored with treatment. |
| Salvageable limb |
Condition of extremity with potential to
secure viability and preserve motor function to the weight-bearing
portion of the foot if treated. |
| Structured exercise program |
Planned program that provides individualized
recommendations for type, frequency, intensity, and duration of
exercise.
|
| Supervised exercise program |
Structured exercise program that takes place
in a hospital or outpatient facility in which intermittent walking
exercise is used as the treatment modality.
Program can be standalone or can be made available within a
cardiac rehabilitation program. Program is directly supervised by qualified healthcare
provider(s). Training is performed for a minimum of 30 to 45 min per
session, in sessions performed at least 3 times/wk for a
minimum of 12 wk.36–46 Patients may not initially achieve
these targets, and a treatment goal is to progress to these
levels over time. Training involves intermittent bouts of walking to
moderate-to-maximum claudication, alternating with periods
of rest. Warm-up and cool-down periods precede and follow each session
of walking.
|
| Structured community- or home-based exercise
program |
Structured exercise program that takes place
in the personal setting of the patient rather than in a clinical
setting.41,47–51
Program is self-directed with the guidance of healthcare
providers who prescribe an exercise regimen similar to that
of a supervised program. Patient counseling ensures that patients understand how to
begin the program, how to maintain the program, and how to
progress the difficulty of the walking (by increasing
distance or speed). Program may incorporate behavioral change techniques, such as
health coaching and/or use of activity monitors.
|
| Emergency versus urgent |
An emergency procedure is one in which life
or limb is threatened if the patient is not in the operating
room or interventional suite and/or where there is time for
no or very limited clinical evaluation, typically within
<6 h. An urgent procedure is one in which there
may be time for a limited clinical evaluation, usually when
life or limb is threatened if the patient is not in the
operating room or interventional suite, typically between 6
and 24 h.
|
| Interdisciplinary care team |
A team of professionals representing different
disciplines to assist in the evaluation and management of the patient
with PAD.
For the care of patients with CLI, the interdisciplinary care
team should include individuals who are skilled in
endovascular revascularization, surgical revascularization,
wound healing therapies and foot surgery, and medical
evaluation and care. Interdisciplinary care team members may include:
Vascular medical and surgical specialists (ie,
vascular medicine, vascular surgery,
interventional radiology, interventional
cardiology) Nurses Orthopedic surgeons and podiatrists Endocrinologists Internal medicine specialists Infectious disease specialists Radiology and vascular imaging specialists Physical medicine and rehabilitation
clinicians Orthotics and prosthetics specialists Social workers Exercise physiologists Physical and occupational therapists Nutritionists/dieticians
|
| Cardiovascular ischemic events |
Acute coronary syndrome (acute MI, unstable
angina), stroke, or cardiovascular death. |
| Limb-related events |
Worsening claudication, new CLI, new lower
extremity revascularization, or new ischemic amputation. |
