Treatment
22
Summary of Recommendations
Recommendation
Grade/
LOE
9.6 Involve a multidisciplinary rehabilitation team from the time a decision
to amputate has been made until successful completion of rehabilitation
has been achieved.
1-C
9.7 Continue to observe CLTI patients who have undergone amputation at
least yearly to monitor progression of disease in the contralateral limb
and to maintain optimal medical therapy and risk factor management.
1-C
10. Postprocedural care and surveillance aer infrainguinal revascularization
for CLTI
10.1 Continue best medical therapy for PAD, including the long-term use
of antiplatelet and statin therapies, in all patients who have undergone
lower extremity revascularization.
1-A
10.2 Promote smoking cessation in all CLTI patients who have undergone
lower extremity revascularization.
1-A
10.3 Consider DAPT (aspirin plus clopidogrel) in patients who have
undergone infrainguinal prosthetic bypass for CLTI for a period of
6–24 months to maintain gra patency.
2-B
10.4 Consider DAPT (aspirin plus clopidogrel) in patients who have
undergone infrainguinal endovascular interventions for CLTI for
≥1 month.
2-C
10.5 Consider DAPT for 1–6 months in patients undergoing repeated
catheter-based interventions if they are at low risk for bleeding.
2-C
10.6 Observe patients who have undergone lower extremity vein bypass
for CLTI on a regular basis for ≥2 years with a clinical surveillance
program consisting of interval history, pulse examination, and
measurement of resting APs and TPs. Consider DUS scanning where
available.
GPS
10.7 Observe patients who have undergone lower extremity prosthetic
bypass for CLTI on a regular basis for ≥2 years with interval history,
pulse examination, and measurement of resting APs and TPs.
GPS
10.8 Observe patients who have undergone infrainguinal endovascular
interventions for CLTI in a surveillance program that includes clinical
visits, pulse examination, and noninvasive testing (resting APs and
TPs).
GPS
10.9 Consider performing additional imaging in patients with lower
extremity vein gras who have a decrease in ABI ≥0.15 and recurrence
of symptoms or change in pulse status to detect vein gra stenosis.
GPS
