Translating Guidelines into Practice: Global Vascular Guideline on the Management of Patients with CLTI

A Series of Three Free Virtual Interactive Roundtable Sessions - Third of Three Sessions

Session 3: Revascularization

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Monday, Oct. 10
6:00 p.m. to 7:30 p.m. Central

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• Speakers
• Moderators
• Audience
• Learning Objectives
• Description
• Schedule 
• Hear from the Moderators

A Multidisciplinary Roundtable Discussion

Featuring Internationally Recognized Speakers in PAD

Patrick J. Geraghty, MD Professor of Surgery Washington University, USA	Leigh Ann O'Banion, MD Assistant Professor of Surgery University of Californiat at San Francisco, USA
Marc Schermerhorn, MD Professor of Surgery Harvard Medical School, USA	Peter A Schneider, MD Professor of Surgery Univeristy of California at San Francisco, USA

Moderators

The moderators of the three sessions are the lead authors of the guidelines being discussed. 

John White, MD Session 1 Moderator

Joseph Mills, MD  Session 2 Moderator

Michael Conte, MD Session 3 Moderator

Audience 

US and internationally-based surgeons (vascular, general, plastic, and orthopedic), interventionalists (radiologists, cardiologists), podiatrists, wound care providers, rehabilitation medicine specialists, orthotists and physical therapists, and residents and trainees in these disciplines, physicians and non-physician clinicians (e.g., nurse practitioners and physician assistants)  involved in the management of patients with Chronic limb-threatening ischemia (CLTI).

Learning Objectives

• Review the rationale and benefit for the use of a limb-based anatomy staging system for CLTI (GLASS); how to perform GLASS staging from angiographic data using the online calculator.
• Review available data linking GLASS staging to revascularization outcomes.
• Discuss the potential impact of pedal artery disease on outcomes of revascularization and the current tools to both assess and potentially treat it
• Discuss current evidence on the risks and benefits of drug-eluting devices in CLTI.

Description

This session will be helpful in expanding physician knowledge base and improving clinical confidence and effectiveness in treating patients with CLTI. The last session of the series will address revascularization. This session will cover GLASS, its relationship to revascularization outcomes, and its current limitations. The growing impact of pedal artery disease in clinical practice will also be discussed. Finally, the panelists will discuss the latest data on the risks and benefits of drug elution in the CLTI population.

The physicians will use a single sample patient to design treatment strategies and demonstrate how to put the recommendations from the global vascular guidelines into practice.  A short survey will be conducted before and after the session, and follow-up survey will follow 60 days later to gauge and evaluate if guidelines were easy to translate into daily clinical practice. Participants will receive the clinical practice guidelines, implementation tools consisting of guideline pocket guides, and link to the app to ensure practicality in aiding participants in improving their clinical practice. 

Session 3 Moderator: Michael Conte, MD

Schedule

• 6:00- 6:05 PM  Pre-Survey
• 6:05- 6:10 PM  Introduction and Overview. Dr. Conte
• 6:10- 6:20 PM  The rationale and benefit for use of a limb-based anatomy staging system for CLTI (GLASS): How to perform GLASS staging from angiographic data using the on-line calculator. Dr. Geraghty
• 6:20- 6:30 PM  The current data linking GLASS staging to revascularization outcomes for patients with CLTI  Dr. Schermerhorn
• 6:30- 6:40 PM  The potential impact of pedal artery disease on outcomes of revascularization: Current tools to assess and treat. Dr. O’Banion
• 6:40- 6:50 PM Current evidence on the risks and benefits of drug-eluting devices in CLTI.  Dr. Schneider
• 6:50- 7:20 PM  Panel Discussion with all speakers and Drs. Conte, Mills and White
• 7:20- 7:30 PM  Post-Survey

Recommended Readings 

1. Mills Sr JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014;59:220e234.e1-2.
2. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH. Global vascular guideline on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6s):1-122.
3. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH. Global vascular guideline on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019 Jul;58(1S):S1-S109.e33.
4. Thanigaimani S, Drovandi A, Golledge J. A meta-analysis of randomized controlled trials evaluating the efficacy of smoking cessation interventions in people with peripheral artery disease. J Vasc Surg. 2022 Feb;75(2):721-729.e7.
5. Bhushan R, Lebwohl MG, Gottlieb AB, Boyer K, Hamarstrom E, Korman NJ, Kirsner RS, Sober AJ, et al. Translating Psoriasis Guidelines into Practice. Important Gaps revealed. J Am Acad Dermatol. 2015