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January 7, 2020

ESVS Publishes 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischemia

January 7, 2020—The European Society for Vascular Surgery (ESVS) announced the publication of the “ESVS 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischemia” online ahead of print in European Journal of Vascular & Endovascular Surgery (EJVES) by Martin Björck, MD, et al.

As stated in the document, an international group of specialists examined the research published on acute limb ischemia (ALI) and summarized the evidence about the best methods of managing this condition. This guideline was produced to help doctors provide the best care for ALI. The focus on the guidelines is on lower limb acute ischemia; however, recommendations are also made on acute upper limb ischemia. The document provides guidance for emergency physicians; vascular, cardiovascular, and general surgeons; angiologists; interventional radiologists; and radiologists.

Specific sections of the document address diagnosis, treatment, postoperative medical treatment and follow-up, registries and quality improvement, acute aortic occlusion with bilateral lower limb ischemia, diagnosis and treatment of acute upper limb ischemia, ALI in children, and unresolved issues and future research.

The guidelines stress the importance of recognizing the signs and symptoms of ALI as characterized by the six Ps: painful, pale, pulseless, parasthesia (numbness), paralyzed, and perishingly cold. Doctors need to be able to assess how bad the ALI is. If it causes numbness or paralysis of the limb, it is very severe and the limb may be impossible to save if not treated within around 6 hours.

Summarizing the guidelines in EJVES, the authors state the following:

“Once the diagnosis of ALI has been made, the guideline group has recommended that patients should be treated by experts (usually a vascular specialist) in a hospital where assessment and treatment is available 24/7. Patients may need to be transferred urgently to a specialist hospital. After assessment, the group recommends patients are treated by experts who are able to use all possible treatments that are available. Until 25 years ago, the only possible treatment for ALI was surgery. Now, there are a variety of clot-busting drugs and new methods of aspirating blood clots percutaneously, without needing an operation.

“The guideline group has looked at all the scientific research on different methods of treating ALI. Both surgical and nonsurgical treatments, such as clot-busting drugs, are effective but with subtly different outcomes depending on individual patients. The group has made recommendations about how to use the different treatments to obtain the best outcomes. The best results seem to be achieved in hospitals used to dealing with patients with ALI and familiar with all the different methods available, choosing the method most suitable for each individual patient. It is hoped these guidelines will be used by doctors treating patients with ALI to give them the best care, thus giving them the best chance for full recovery without complications.”

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