EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists
|
|
|
- Alexandra Burke
- 5 years ago
- Views:
Transcription
1 EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists
2 Nothing To Disclosure
3 DISCLOSURES I have no outside conflicts of interest, financial incentives, or other disclosures
4 OBJECTIVES Identify when further Vascular intervention is indicated What is the initial foot evaluation What can Physical Exam tell us What tests should be ordered as part of the initial work up Describe and Define the various modalities available for further evaluation Define a potential treatment algorithm when vascular compromise is suspected.
5 65M PRESENTS TO CLINIC
6 EPIDEMIOLOGY Diabetes in the most common cause of Foot ulcers Infections Ischemia Amputations ~25% of diabetic pts will get an ulcer 50% of diabetic foot ulcers get infected 20% of these require amputation 85% of all diabetic lower extremity amputation are preceded by ulceration
7 AMPUTATION 90,000 amputations are done on diabetics each year 70-80% of non-traumatic amputations are done on diabetics Up to 17% will require a 2 nd amputation during the first year After one limb is injured, 50% will develop a serious wound on the contralateral limb Up to 70% will lose their other limb within 5 years
8 AMPUTATION 5 year mortality rate for major lower extremity amputations
9 PROGRESSION OF DISEASE Diabetes Neuropathy PAD Ulceration Infection Amputation
10 CAUSES OF ULCERS Neuropathy Autonomic, Motor, Sensory Abnormal Mechanics Bony Deformity PAD Trauma Ulceration Poorly Fitting Shoes
11 CAUSES OF ULCERS Ischemia Diabetic Neuropathy
12 CLINICAL PRESENTATION Ulcers can involve any part of the toes, foot, or ankle Complicated by Neuropathy May, or may not, present with claudication Be worried if: Pain Drainage Malodor Signs of Infection
13 DIABETIC FOOT RISK ASSESSMENT History Foot wounds? Amputations? Prior Surgery (Bypass/Stent) Exam Check for pulses Evaluate the Skin Check for neuropathy Look for Ulcers Foot Structure Joint Mobility
14 EARLY WORKUP Checking pulses Femoral Popliteal Posterior Tibial Dorsalis Pedis
15 DIABETES Creager M A et al. Circulation 2003;108: Copyright American Heart Association
16 EARLY WORKUP
17 EARLY WORKUP Checking pulses Evaluate the Skin Dry Hairless Dependent Rubor
18 EARLY WORKUP Checking pulses Evaluate the Skin Evaluate for Neuropathy
19 EARLY WORKUP Checking pulses Evaluate the Skin Evaluate for Neuropathy Look for Ulcers Check between toes In Creases Socks and shoes are off
20 EARLY WORKUP Checking pulses Evaluate the Skin Check for Neuropathy Look for Ulcers Classify the Ulcer Depth, size Infection Probe to Bone PPV (~50%) NPV (97%) Lavery LA et al. Diabetes Care 2007; 30:
21 ULCER CLASSIFICATION IWGDF International Work Group for Diabetic Foot No Issues Neuropathy A: Neuropathy & deformity B: PAD A: Hx of Ulcer B: Amputation Meggitt-Wagner Grade Description 0 Pre-ulcerative lesion 1 Superficial Ulcer 2 Deep Ulcer 3 Deep Ulcer with Infection 4 Forefoot Gangrene 5 Whole foot Gangrene
22 UNIVERSITY OF TEXAS WOUND CLASSIFICATION SYSTEM Class A B C D Pre-ulcerative Healed +Infection - PAD -Infection +PAD +Infection +PAD Wound Depth Superficial Skin/Sub-Q +Infection - PAD -Infection +PAD +Infection +PAD Deep Tendon/Capsule +Infection - PAD -Infection +PAD +Infection +PAD Deep Bone/Joint +Infection - PAD -Infection +PAD +Infection +PAD Armstrong DG et al. Diabetes Care 1998; 21:
23 MULTI-SPECIALTY CARE
24 PREDICTING ULCER HEALING ABI Toe Pressures TcPO2 Duplex Arterial Imaging
25 NON-INVASIVE TESTING ABI The reference standard for PAD Sensitivity 97% Specificity 100% In Diabetics -due to calcification- ABI falsely elevated (falsely normal) ABI >1.3 requires additional testing
26 NON-INVASIVE TESTING ABI The reference standard for PAD Sensitivity 97% Specificity 100% In Diabetics -due to calcification- ABI falsely elevated (falsely normal) ABI >1.3 requires additional testing
27 NON-INVASIVE TESTING ABI The reference standard for PAD Sensitivity 97% Specificity 100% In Diabetics -due to calcification- ABI falsely elevated (falsely normal) ABI >1.3 requires additional testing Yao JST. Br J Surg. 1970;57:761
28 NON-INVASIVE TESTING TOE PRESSURES Usually accurate in Diabetics Digital arteries are seldom calcified
29 NON-INVASIVE TESTING TOE PRESSURES Usually accurate in Diabetics Digital arteries are seldom calcified Ramsey DE. J Cardiovasc Surg. 1983;24:43.
30 NON-INVASIVE TESTING SEGMENTAL PRESSURES Give hints as to the level of disease A decrease of >20mmHg at any level indicates dignificant disease Normal Iliac SFA Iliac & SFA Below Knee Arm Upper Thigh Above Knee Below Knee Ankle
31 NON-INVASIVE TESTING PITFALLS Using L or R UE pressure: want to take the higher of the two Failure to have pt supine for 5 minutes or longer Proper cuff size Small (higher pressure), Large (lower pressure)
32 NON-INVASIVE TESTING DOPPLER/DUPLEX Normal flow is brisk triphasic Arterial stenosis flattens the waveform Doppler looks at flow and can determine Shift f = 2Vf 0CCCC C
33 NON-INVASIVE TESTING DOPPLER/DUPLEX
34 NON-INVASIVE TESTING DOPPLER/DUPLEX Stenosis (%) Peak Velocity (cm/s) Velocity Ratio Distal Artery waveform <20% <150 <1.5 Triphasic, normal PSV 20-49% Triphasic, normal PSV 50-75% Monophasic, reduced PSV >75% >300 4 Damped, monophasic
35 NON-INVASIVE TESTING DOPPLER/DUPLEX Highly user dependent Velocity across multi-level stenosis is less reliable Critical Stenosis Loss of triphasic waveform Broadening with PSV >200
36 NON-INVASIVE TESTING TCPO2 Skin probes measure ppo2 Essentially looks at the extra oxygen available TcPO2 of 0 means that all diffusing oxygen has been consumed
37 NON-INVASIVE TESTING TCPO2 Normal >55 Marginal healing Poor healing <20
38 NON-INVASIVE TESTING TCPO2 Factors affecting TcPO2 Skin temperature Sympathetic tone Body Temperature Cellulitis Hyperkeratosis Obesity Edema Metabolic Activity Oxygen diffusion through tissue Oxyhemaglobin curve Increased venous Pressure Vertical Position relative to the heart Age
39 SO WHAT S THE KEY!
40 DON T WAIT TOO LONG!
41 WHEN AN ULCER IS PRESENT Careful Foot Exam?Pulses? No ABI Testing Arterial Duplex <0.5 Yes >0.5 Local Wound Treatment Charcot Evaluation Medical Adjuncts Vascular Evaluation Arterial Imaging Endovascular Options Surgical Options Amputation Debridement
42 QUESTIONS?
Disclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium
Disclosures Vascular Testing in the CLI Patient None 2015 UCSF Vascular Symposium Warren Gasper, MD Assistant Professor of Surgery UCSF Division of Vascular Surgery Critical Limb Ischemia Chronic Limb
Practical Point in Holistic Diabetic Foot Care 3 March 2016
Diabetic Foot Ulcer : Vascular Management Practical Point in Holistic Diabetic Foot Care 3 March 2016 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai
Perfusion Assessment in Chronic Wounds
Perfusion Assessment in Chronic Wounds American Society of Podiatric Surgeons Surgical Conference September 22, 2018 Michael Maier, DPM, FACCWS Cardiovascular Medicine Cleveland Clinic Disclosures Speaker,
Arterial Studies And The Diabetic Foot Patient
Arterial Studies And The Patient George L. Berdejo, BA, RVT, FSVU gberdejo@wphospital.org Disclosures I have nothing to disclose! Diabetes mellitus continues to grow in global prevalence and to consume
Due to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice.
A summary Disclaimer The information contained in this document is intended to provide general information only. It is not intended to be, nor does it constitute, medical advice. Under no circumstances
Will it heal? How to assess the probability of wound healing
Will it heal? How to assess the probability of wound healing Richard F. Neville, M.D. Professor of Surgery Chief, Division of Vascular Surgery George Washington University Limb center case 69 yr old male
The Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care
The Diabetic Foot Screen and Management Foundation Series of Modules for Primary Care Anita Murray - Senior Podiatrist Diabetes, SCH Learning Outcomes Knowledge of the Model of Care For The Diabetic Foot
UC SF. Disclosures. Vascular Assessment of the Diabetic Foot. What are the best predictors of wound healing? None. Non-Invasive Vascular Studies
Disclosures Vascular Assessment of the Diabetic Foot What are the best predictors of wound healing? None Shant Vartanian MD Assistant Professor of Vascular Surgery UCSF Vascular Symposium April 20, 2013
VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS
VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS KANSAS ASSOCIATION OF OSTEOPATHIC MEDICINE ANNUAL CME CONVENTION APRIL 13, 2018 THREE
Aetiology Macroangiopathy occurs mainly distally ie Popliteal artery There is arterial wall calcification Microangiopathy is less common
DIABETIC FOOT Facts 5% of the population is diabetic 12% of diabetic admissions are with foot problems 1/3rd of diabetic foot ulcerations are neuropathic, 1/3rd are ischaemic and 1/3 are of a mixed in
Lower Extremity Artery: Physiologic Testing
Master Title Ultrasound for Initial Evaluation of Lower Extremity Arterial Occlusive Disease: WHY? Gregory L. Moneta MD Professor and Chief Knight Cardiovascular Institute Division of Vascular Surgery
Practical Point in Diabetic Foot Care 3-4 July 2017
Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University
Non-invasive examination
Non-invasive examination Segmental pressure and Ankle-Brachial Index (ABI) The segmental blood pressure (SBP) examination is a simple, noninvasive method for diagnosing and localizing arterial disease.
Non- invasive vascular testing. Pros and Cons of ABIs and Alternative Physiologic Assessments
Non- invasive vascular testing Pros and Cons of ABIs and Alternative Physiologic Assessments Non- Invasive Physiologic Arterial Studies Segmental Systolic Pressure Measurements ABIs, TBIs, and full segmentals
Diabetic Foot Ulcers. Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C. Advanced Practice Nurse / Adult Clinical Nurse Specialist
Diabetic Foot Ulcers Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist Organization of Wound Care Nurses www.woundcarenurses.org Objectives Identify Diabetic/Neuropathic
Definitions and criteria
Several disciplines are involved in the management of diabetic foot disease and having a common vocabulary is essential for clear communication. Thus, based on a review of the literature, the IWGDF has
Imaging Strategy For Claudication
Who are the Debators? Imaging Strategy For Claudication Duplex Ultrasound Alone is Adequate to Select Patients for Endovascular Intervention - Pro: Dennis Bandyk MD No Disclosures PRO - Vascular Surgeon
How to manage leg ulcers in the elderly
How to manage leg ulcers in the elderly David Riding Clinical Research Fellow / Specialty Registrar in Vascular Surgery University of Manchester / MFT British Geriatric Society Trainees Meeting 2018 Objectives
PUT YOUR BEST FOOT FORWARD
PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.
Limb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017
Limb Salvage in Diabetic Ischemic Foot Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Case Male 67 years old Underlying DM, HTN, TVD Present with gangrene
Introduction History Preceded by Arterial Doppler and ABI Indications
Elise Brady, RVT, RDMS Introduction History Preceded by Arterial Doppler and ABI Indications 1) Abnormal ABI (within 2weeks of duplex) 2) Abnormal Doppler waveforms 3) Claudication 4) History of PVD 5)
Pedal Bypass With Deep Venous Arterialization:
Pedal Bypass With Deep Venous Arterialization: Long Term Result For Critical Limb Ischemia With Unreconstructable Distal Arteries Pramook Mutirangura Professor of Vascular Surgery Faculty of Medicine Siriraj
Peripheral Arterial Disease Extremity
Peripheral Arterial Disease Lower Extremity 05 Contributor Dr Steven Chong Advisors Dr Ashish Anil Dr Tay Jam Chin Introduction Risk Factors Clinical Presentation Classification History PHYSICAL examination
USWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential
USWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential MEASURE STEWARD: The US Wound Registry [Note: This measure
ASSESSING THE VASCULAR STATUS OF THE FEET FOR PATIENTS WITH DIABETES
ASSESSING THE VASCULAR STATUS OF THE FEET FOR PATIENTS WITH DIABETES Caroline McIntosh is Senior Lecturer in Podiatry, University of Huddersfield, Yorkshire A reduced blood supply to the lower limb, due
Clinical Approach to CLI and Related Diagnostics: What You Need to Know
Clinical Approach to CLI and Related Diagnostics: What You Need to Know Ido Weinberg, MD Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital None Disclosures Critical
Imaging for Peripheral Vascular Disease
Imaging for Peripheral Vascular Disease James G. Jollis, MD Director, Rex Hospital Cardiovascular Imaging Imaging for Peripheral Vascular Disease 54 year old male with exertional calf pain in his right
Introduction. Epidemiology Pathophysiology Classification Treatment
Diabetic Foot Introduction Epidemiology Pathophysiology Classification Treatment Epidemiology DM largest cause of neuropathy in N.A. 1 million DM patients in Canada Half don t know Foot ulcerations is
My Diabetic Patient Has No Pulses; What Should I Do?
Emily Malgor, MD Assistant Professor of Surgery University of Oklahoma, Oklahoma City My Diabetic Patient Has No Pulses; What Should I Do? There are no disclosures. Background Diabetes affects 387 million
Fluorescent Angiography: Practical uses in the Clinical Setting
Fluorescent Angiography: Practical uses in the Clinical Setting Charles Andersen MD, FACS, MAPWCA Chief Vascular/Endovascular/ Limb Preservation Surgery Service (Emeritus) Chief of Wound Care Service Madigan
Disclosures. Talking Points. An initial strategy of open bypass is better for some CLI patients, and we can define who they are
An initial strategy of open bypass is better for some CLI patients, and we can define who they are Fadi Saab, MD, FASE, FACC, FSCAI Metro Heart & Vascular Metro Health Hospital, Wyoming, MI Assistant Clinical
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease Difference in AAA size between US and Surgeon 2 1 0-1 -2-3 0 1 2 3 4 5 6 7 Mean AAA size between US and Surgeon Kathleen G. Raman MD,
Vascular screening in diabetic patients: how aggressive should we be and when to intervene?
Vascular screening in diabetic patients: how aggressive should we be and when to intervene? Roberto Ferraresi Peripheral Interventional Unit Bergamo Italy Disclosure Speaker name: ROBERTO FERRARESI X X
Introduction to Peripheral Arterial Disease. Stacey Clegg, MD Interventional Cardiology August
Introduction to Peripheral Arterial Disease Stacey Clegg, MD Interventional Cardiology August 20 2014 Outline (and for the ABIM board exam * ** ***) Prevalence* Definitions Lower Extremity: Aorta*** Claudication***
I have no financial interests to disclose in regards to this lecture.
Evaluation and Treatment of Diabetic Foot Ulcerations John M. Giurini, D.P.M. Associate Professor in Surgery Harvard Medical School Disclosure Statement I have no financial interests to disclose in regards
National Clinical Conference 2018 Baltimore, MD
National Clinical Conference 2018 Baltimore, MD No relevant financial relationships to disclose Wound Care Referral The patient has been maximized from a vascular standpoint. She has no other options.
Peripheral Arterial Disease. Westley Smith MD Vascular Fellow
Peripheral Arterial Disease Westley Smith MD Vascular Fellow Background (per 10,000) Goodney P, et al. Regional intensity of vascular care and lower extremity amputation rates. JVS. 2013; 6: 1471-1480.
Diabetic Foot Ulcer Treatment and Prevention
Diabetic Foot Ulcer Treatment and Prevention Alexander Reyzelman DPM, FACFAS Associate Professor California School of Podiatric Medicine at Samuel Merritt University Diabetic Foot Ulcers One of the most
High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC
High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC A new paradigm? Foot ulceration 101 Assessing Perfusion a new challenge Pressure
AN INTRODUCTION TO DOPPLER. Sarah Gardner, Clinical lead, Tissue viability service. Oxford Health NHS Foundation Trust.
AN INTRODUCTION TO DOPPLER Sarah Gardner, Clinical lead, Tissue viability service. Oxford Health NHS Foundation Trust. THE DOPPLER EFFECT The Doppler Principle was described by Physicist and mathematician
V.A. is a 62-year-old male who presents in referral
, LLC an HMP Communications Holdings Company Clinical Case Update Latest Trends in Critical Limb Ischemia Imaging Amit Srivastava, MD, FACC, FABVM Interventional Cardiologist Bay Area Heart Center St.
Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) Certified Foot Care Nurse (CFCN) Detailed Content Outline
Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) Certified Foot Care Nurse (CFCN) Detailed Content Outline Description Domain I: Assessment and Care Planning 010000 40 Task 1: Obtain focused
1 of :19
1 of 8 3-12-2012 12:19 Diabetic foot ulcer classification system for research purposes Introduction Aims of the ulcer research classification system Definitions and categorisation for the ulcer research
Diabetic/Neuropathic Foot Ulcer Assessment Guide South West Regional Wound Care Program Last Updated April 7,
Developed in collaboration with the Wound Care Champions, Wound Care Specialists, Enterostomal Nurses, and South West Regional Wound Care Program (SWRWCP) members from Long Term Care Homes, Hospitals,
Approach to the Patient with (suspected) Arterial Insufficiency Related Ulceration
Approach to the Patient with (suspected) Arterial Insufficiency Related Ulceration Elisa C. Taffe, MD, CWSP Vascular Medicine Medical Director Allegheny General Advanced Wound Healing and Lymphedema Center
Objective assessment of CLI patients Hemodynamic parameters
Objective assessment of CLI patients Hemodynamic parameters Worth anything in end stage patients? Marianne Brodmann Angiology, Medical University Graz, Austria Disclosure Speaker name: Marianne Brodmann
Larry Diaz, MD, FSCAI Mehdi H. Shishehbor, DO, FSCAI
PAD Diagnosis Larry Diaz, MD, FSCAI Metro Health / University of Michigan Health, Wyoming, MI Mehdi H. Shishehbor, DO, FSCAI University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH PAD:
Appendix D: Leg Ulcer Assessment Form
Nursing Best Practice Guideline Appendix D: Ulcer Assessment Form Person Completing Assessment: Date: Client Name: Caf # CM# VON ID #: District CCAC ID # Address Telephone Home: Work: Date of Birth Y/M/D:
Diabetic Foot Complications
Diabetic Foot Complications Podiatry Specialty Clinic YKHC Bethel, Alaska August 1-3, 2017 Charles C. Edwards, DPM Alaska Native Tribal Health Consortium Peripheral Neuropathy Diabetic Peripheral Neuropathy
Vascular Surgery Cases: Detours. Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists
Vascular Surgery Cases: Detours Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists Brian.Stull@Unchealth.unc.edu Objectives Anatomy of a bypass graft Where does it connect, where does it
Acknowledgements. No tengo conflictos de interés que revelar. I have no conflicts of interest to disclose. Michael S. Conte. David G.
No tengo conflictos de interés que revelar I have no conflicts of interest to disclose. Critical Limb Ischemia : The Need for a New System to Define Disease Burden and Stratify Amputation Risk and Need
AWMA MODULE ACCREDITATION. Module Five: The High Risk Foot (Including the Diabetic Foot)
AWMA MODULE ACCREDITATION Module Five: The High Risk Foot (Including the Diabetic Foot) Introduction - The Australian Wound Management Association Education & Professional Development Sub Committee-(AWMA
GLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE
GLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE Michael S. Conte MD Professor and Chief, Vascular and Endovascular Surgery Co-Director, Center for Limb Preservation Co-Director, Heart and Vascular
Radiologic Evaluation of Peripheral Arterial Disease
January 2003 Radiologic Evaluation of Peripheral Arterial Disease Grace Tye, Harvard Medical School Year III Patient D.M. CC: 44 y/o male with pain in his buttocks Occurs after walking 2 blocks. Pain is
Clinical assessment of diabetic foot in 5 minutes
Clinical assessment of diabetic foot in 5 minutes Assoc. Prof. N. Tentolouris, MD 1 st Department of Propaedeutic Internal Medicine Medical School Laiko General Hospital Leading Innovative Vascular Education
Integumentary Physical Therapy 피부계물리치료학
Integumentary Physical Therapy 피부계물리치료학 Dong-Ryul Lee, PT, Ph.D. Movement Impairment Specialist & Performance Enhancement Specialist Neurofeedback, Robotics & Virtual Reality Research Specialites: NeuroRehabilitation
Current Vascular and Endovascular Management in Diabetic Vasculopathy
Current Vascular and Endovascular Management in Diabetic Vasculopathy Yang-Jin Park Associate professor Vascular Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Peripheral artery
Now That You Have the Tools
blockosu@gmail.com Now That You Have the Tools Alan Jay Block, DPM, MS, FASPS, FACFAS Assistant Professor Dept Of Orthopeadics The Ohio State University Medical Board Kent State University Editor-in -Chief
The Diabetic Foot Latest Statistics
The Diabetic Foot Latest Statistics There are 2.6 million people with diagnosed diabetes in the UK. There are predicted to be 500,000 who have the condition but are unaware of it. There are 11,859 in TH
Vascular Assessment of the Lower Limb. Anita Roberts RGN MBA
Vascular Assessment of the Lower Limb Anita Roberts RGN MBA Peripheral Arterial Disease A marker for future vascular disease (CHD and stroke) In Europe and North America an estimated 27 million people
Management Of The Diabetic foot
Management Of The Diabetic foot Aims, Pathways, Treatments Nikki Coates 12/1/18 Diabetic foot pathology Neuropathy Foot deformity Vascular disease Sensory neuropathy Limited Joint Mobility Smoking Autonomic
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
Leg ulcer assessment and management
Leg ulceration The views expressed in this presentation are solely those of the presenter and do not necessarily represent the views of Smith & Nephew. Smith & Nephew does not guarantee the accuracy or
Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI?
Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI? Peter F. Lawrence, M.D. Gonda Vascular Center Division of Vascular Surgery
DIABETIC FOOT SCOPE OF THE PROBLEM. Hanan Gawish, Mansoura University Egypt Representative of the IWGDF
DIABETIC FOOT SCOPE OF THE PROBLEM Hanan Gawish, Mansoura University Egypt Representative of the IWGDF Agenda Definition of DF Diabetic Foot among Diabetes complication Risk factors for amputation Risk
Global Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care
Global Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care Michael S. Conte MD Professor and Chief, Division of Vascular and Endovascular
Lower Extremity Arterial Doppler
Lower Extremity Arterial Doppler 1. Spectral Doppler waveform should be taken in distal aorta and common iliac arteries. 2. R/L common femoral artery (CFA) color Doppler with velocity and B-mode. 3. R/L
Pre-operative management: risk assessment
Pre-operative management: risk assessment Dr. B. Drieghe 21 st of April 2018 Moderators: Prof. Dr. S. Motte and Prof. Dr. P. Verhamme VASCULAR ISSUES IN TYPE 2 DIABETES MURIEL SPRYNGER University Hospital
SAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS
SAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS LIBBY WATCH, MD MIAMI VASCULAR SPECIALISTS MIAMI CARDIAC & VASCULAR INSTITUTE FINANCIAL DISCLOSURES None 2
Statistics on DM and DFU risk
Disclosure NOTHING Statistics on DM and DFU risk National Institute of Diabetes Digestive & Kidney Diseases: As of September 2011 an estimated 16 million Americans are known to have diabetes, with many
1 Ankle Brachial Pressure Index
1 Ankle Brachial Pressure Index Stuart Wind Video Time 3 mins 42 s Overview The Ankle-Brachial Pressure Index (ABPI) is a very useful non-invasive test which can quickly identify the presence and severity
Validation and Clinical Utility of the SVS WIfI Threatened Limb Classification
Validation and Clinical Utility of the SVS WIfI Threatened Limb Classification PRESENTED BY: 11 th Houston Aortic Symposium 15 February 2018 Joseph L. Mills, Sr., M.D. Reid Endowed Professor of Surgery
FOR THE 18 MILLION INDIVIDUALS with diabetes mellitus in
11 Evaluation and Management of Peripheral Arterial Disease Joseph L. Mills, Sr., MD FOR THE 18 MILLION INDIVIDUALS with diabetes mellitus in the United States, foot problems ulceration, infection, and
Resident Teaching Conference 3/12/2010
Resident Teaching Conference 3/12/2010 Goals Definition and Classification of Acute Limb Ischemia Clinical Assessment of the Vascular Patient History and Physical Diagnostic Modalities Management of Acute
Access strategy for chronic total occlusions (CTOs) is crucial
Learn How Access Strategy Impacts Complex CTO Crossing Arthur C. Lee, MD The Cardiac & Vascular Institute, Gainesville, Florida VASCULAR DISEASE MANAGEMENT 2018;15(3):E19-E23. Key words: chronic total
Peripheral Arterial Disease: Who has it and what to do about it?
Peripheral Arterial Disease: Who has it and what to do about it? Seth Krauss, M.D. Alaska Annual Nurse Practitioner Conference September 16, 2011 Scope of the Problem Incidence: 20%
Arterial & Venous Ulcers. A Comprehensive Review Assessment & Management
Arterial & Venous Ulcers A Comprehensive Review Assessment & Management 1 Objectives Understand Arterial & Venous disease Understand the etiology of lower extremities ulcers Understand assessment of lower
Clinical Examination of VASCULAR PATIENTS. Stephanie Hirst & Alexander Sunde
Clinical Examination of VASCULAR PATIENTS Stephanie Hirst & Alexander Sunde Goals of Medical History To record the patient s symptoms at time of presentation. To organize the events which have lead to
ULCERS 1/12/ million diabetics in the US (2012) Reamputation Rate 26.7% at 1 year 48.3% at 3 years 60.7% at 5 years
Jay Christensen D.P.M Advanced Foot and Ankle of Wisconsin 2-4% of the population at any given time will have ulcers 0.06-0.20% of the total population Average age of patients 70 years increased as more
Lower Extremity Peripheral Arterial Disease: Its All About the Pulse. Spence M Taylor, M.D.
Lower Extremity Peripheral Arterial Disease: Its All About the Pulse Spence M Taylor, M.D. President, Greenville Health System Clinical University Senior Associate Dean for Academic Affairs and Diversity
The Diabetic foot. diabetic. foot. the
The Diabetic Some basic facts. Diabetes is on increase. Foot ulcers occur in 12% to 25% of people with diabetes. Diabetics who have had a ulcer are more likely to have a re occurrence. Diabetes is biggest
Surgical Options for revascularisation P E T E R S U B R A M A N I A M
Surgical Options for revascularisation P E T E R S U B R A M A N I A M The goal Treat pain Heal ulcer Preserve limb Preserve life The options Conservative Endovascular Surgical bypass Primary amputation
Endovascular Intervention BtK Intervention in Patients with Chronic Dialysis
Endovascular Intervention BtK Intervention in Patients with Chronic Dialysis GB Danzi, MD Ospedale Maggiore Policlinico Milan Italy Disease Pattern in PAD Hypercholesterolemia Age ESRD Current smoking
Rapid Recovery Hyperbarics 9439 Archibald Ave. Suite 104 Rancho Cucamonga CA,
Foot at risk Age Well By Dr LIEW NGOH CHIN Are limb amputations due to diabetes preventable? DIABETES mellitus is a major global health problem and has reached epidemic proportions in many developed and
Diabetic/Neuropathic Foot Ulcer Assessment Guide South West Regional Wound Care Program Last Updated June 10,
Developed in collaboration with the Wound Care Champions, Wound Care Specialists, Enterostomal Nurses, and South West Regional Wound Care Program (SWRWCP) members from Long Term Care Homes, Hospitals,
Clasificación WIFI: Finalmente hablaremos el mismo idioma! WIfI: Wound, Ischemia, foot Infection The SVS Threatened Limb Classification
Clasificación WIFI: Finalmente hablaremos el mismo idioma! WIfI: Wound, Ischemia, foot Infection The SVS Threatened Limb Classification Joseph L. Mills, Sr., M.D. Professor of Surgery, Chief, Vascular
Disclosures. Tips and Tricks for Tibial Intervention. Tibial intervention overview
Tips and Tricks for Tibial Intervention Donald L. Jacobs, MD C Rollins Hanlon Endowed Professor and Chair Chair of Surgery Saint Louis University SSM-STL Saint Louis University Hospital Disclosures Abbott
Peripheral Vascular Examination. Dr. Gary Mumaugh Western Physical Assessment
Peripheral Vascular Examination Dr. Gary Mumaugh Western Physical Assessment Competencies 1. Inspection of upper extremity for: size symmetry swelling venous pattern color Texture nail beds Competencies
Lower Extremity Arterial Duplex Evaluation
VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Lower Extremity Arterial Duplex Evaluation This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound
CLI Therapy- LINCed Multi disciplinary discussions on CLI
CLI Therapy- LINCed Multi disciplinary discussions on CLI Critical limb ischemia and managing the infected wound Michiel Schreve North West Clinics Alkmaar, The Netherlands Disclosure Speaker name: Michiel
Diabetes Foot and Skin Care. Diabetes and the feet. Foot problems: Major cause of morbidity and mortality
Session # 11 Diabetes Foot and Skin Care Betty Harvey, RNEC BScN MScN Amanda Mikalachki, RN BScN CDE Diabetes and the feet Diabetes affects circulation and immunity. Over time, the sensory nerves in the
Happy Feet: Feeling good about diabe.c foot screening! Family Medicine Forum 2014, Quebec City November 14, 2014
Happy Feet: Feeling good about diabe.c foot screening! Family Medicine Forum 2014, Quebec City November 14, 2014 Dr. Michael Yan, MD, CCFP Clinical Lecturer, Department of Family Medicine, University of
Rapid Foot Screening
GP Symposium 2015 Workshop Rapid Foot Screening Ms Chelsea Law, Principal Podiatrist Mr Henry Lee, Podiatrist Ms Ng Jia Lin, Podiatrist Ms Polly Lim, Podiatrist Ms Wong Wan Mun, Podiatrist Mr Yeo Boon
HOW TO USE A DOPPLER IN YOUR PRACTICE
GPCME Conference June 2014 Bridget Rood USL Medical Presents.. HOW TO USE A DOPPLER IN YOUR PRACTICE Disclosure I am a NZRN and currently work at USL Medical as a Product Manager USL Medical are the exclusive
No financial or commercial relationships to disclose
Deanna New, RVT No financial or commercial relationships to disclose IAC REQUIREMENTS: The main duty of a sonographer is to make the physician or radiologists job easier by capturing images and doing
Fluorescence Angiography in Limb Salvage
Fluorescence Angiography in Limb Salvage Ryan H. Fitzgerald, DPM, FACFAS Associate Professor of Surgery-University Of South Carolina School of Medicine, Greenville Etiology of Lower extremity wounds Neuropathy
NADINE R. BARSOUM, M.D.; LAMIAA I.A. METWALLY, M.D. and IMAN M. HAMDY IBRAHIM, M.D.
Med. J. Cairo Univ., Vol. 84, No. 2, December: 175-183, 2016 www.medicaljournalofcairouniversity.net Peripheral Arterial Disease of the Lower Limbs: Is Doppler Examination as Efficient in its Diagnosis
Indications: following: embolization. artery that has diseases 5. The evaluation. of suspected. such entities. a cold hand. biopsy
Peripheral Arterial Ultrasound Protocol Using Color and Spectral Doppler Reviewed by: Mark Yuhasz, MD Last Review Date: January 2015 Contact: (866) 761 4200, Option 1 Indications: The indications for peripheral
Combat Extremity Vascular Trauma
Combat Extremity Vascular Trauma Training teams to be a TEAM Chatt A. Johnson LTC, MC, USA 08 March 2010 US Army Trauma Training Center Core Discussion Series Outline: Combat Vascular Injury Physiologic