Towards Standardized, Safe and Efficacious Screening Approaches to Patients with Lower Extremity Peripheral Arterial Disease in the setting of Lower Extremity Arthroplasty
Research Mentor Name
Dr. Khaled J Saleh
Research Mentor Email Address
Institution / Department
School of Medicine; DMC Department of Orthopedic Surgery
Level of Research
INTRODUCTION: Peripheral arterial disease (PAD) impedes recovery from lower extremity arthroplasties (LEA) and increases risk of complications/mortality, yet there aren’t standards for screening PAD patients pre-LEA. This review proposes some.
METHODS: This review searched databases for articles containing relevant terms. Non-English articles, those unrelated to LEA, and duplicates were excluded. Articles were cross-referenced to find other relevant papers for a total of 111.
RESULTS: Up to 49.2% of PAD patients have CAD. Wagner grade III/IV ulcers increase amputations and decrease wound closures. The Wound, Ischemia, and Foot Infection (WIfI) system provides more accurate, and therefore actionable, assessment. Overlooking PAD in surgery patients is linked to sequelae from tourniquets. Arterial calcification increases risk of perioperative blood loss from vascular compression, anemia, and critical limb ischemia. Compounding risk factors for PAD (diabetes, smoking, etc.) increase likelihood of future PAD diagnosis.
If SBP>180 or DBP>110 mmHg, forgo elective surgery. Non-cardiac surgery patients with hypertension should receive a beta-blocker one day pre-surgery and perioperatively. Smoking cessation four weeks preoperatively and abstinence four weeks postoperatively may halve wound complications. Absent/asymmetrical pulses should prompt vascular referral pre-LEA. ABI may be falsely normal in asymptomatics with moderate aortoiliac stenosis. Risk of hematoma formation and LEA infection suggests waiting one year while continuing antiplatelet therapy.
DISCUSSION/CONCLUSIONS: Adequate blood flow is imperative peri- and postoperatively for optimal healing from LEA. Before orthopedic surgery, we suggest meticulous history and assessment to identify PAD risk factors and determine tolerance for surgical intervention. Patients should be stratified for amputation risk and revascularization benefit using the WIfI system. ABI should be performed to assess severity of vascular stenosis. Patients <0.9 should receive vascular consultation, then reassessment. These recommendations could help clinicians assign vascular intervention pre-LEA, minimize complications/reoperations, truncate spending, and improve patient satisfaction/well-being.
Cardiovascular Diseases | Medicine and Health Sciences | Orthopedics
Khoury, Zaina N.; Pearl, Adam; Hassan, Ahmad; Awad, Mohamed; and Saleh, Khaled, "Towards Standardized, Safe and Efficacious Screening Approaches to Patients with Lower Extremity Peripheral Arterial Disease in the setting of Lower Extremity Arthroplasty" (2023). Medical Student Research Symposium. 211.