المؤلفون: Houghton, John S M^1,2,3 john.houghton@nhs.net, Saratzis, Athanasios N^1,2,3, Sayers, Rob D^1,2,3, Haunton, Victoria J⁴

المصدر: Age & Ageing. Jun2024, Vol. 53 Issue 6, p1-10. 10p.

مصطلحات موضوعية: *PERIPHERAL vascular disease treatment, *ISCHEMIA, *PERIPHERAL vascular diseases, *EXERCISE therapy, *FRAIL elderly, *DECISION making, *FIBRINOLYTIC agents, *ENDOVASCULAR surgery, *POLYPHARMACY, *CEREBRAL revascularization, *ATORVASTATIN, *CARDIOVASCULAR surgery, *COGNITION disorders, *PERIOPERATIVE care, *COMORBIDITY, *DISEASE risk factors, *DISEASE complications, *OLD age, PERIPHERAL vascular disease diagnosis

مستخلص: Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent claudication, whilst chronic limb-threatening ischaemia (CLTI), the end stage of PAD, presents with rest pain and/or tissue loss. PAD is an age-related condition present in over 10% of those aged ≥65 in high-income countries. Guidelines regarding definition, diagnosis and staging of PAD and CLTI have been updated to reflect the changing patterns and presentations of disease given the increasing prevalence of diabetes. Recent research has changed guidelines on optimal medical therapy, with low-dose anticoagulant plus aspirin recommended in some patients. Recently published randomised trials highlight where bypass-first or endovascular-first approaches may be optimal in infra-inguinal disease. New techniques in endovascular surgery have increased minimally invasive options for ever more complex disease. Increasing recognition has been given to the complexity of patients with CLTI where a high prevalence of both frailty and cognitive impairment are present and a significant burden of multi-morbidity and polypharmacy. Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams. [ABSTRACT FROM AUTHOR]

المؤلفون: Estrella, Jewel¹, George, Simi¹, Hariri, Dana², Zaccarini, Daniel J.², Sura, Anjali¹ suraa@upstate.edu

المصدر: Clinical Pediatrics. Jul2024, Vol. 63 Issue 7, p1013-1016. 4p.

مصطلحات موضوعية: *SKIN disease diagnosis, *BIOPSY, *BLOOD testing, *COMPUTED tomography, *ULTRASONIC imaging, *SKIN, *FLUORESCENCE in situ hybridization, *MAGNETIC resonance angiography, *MYELOID leukemia, *GENETIC mutation, VASCULAR disease diagnosis

مستخلص: The article focuses on cutaneous vasculitis as an initial sign of juvenile myelomonocytic leukemia (JMML), emphasizing the importance of considering leukemia in patients presenting with vasculitis. Topics include the triad of leukocytosis, anemia, and thrombocytopenia as indicative of JMML, along with the significance of bone marrow biopsy in confirming the diagnosis.

المؤلفون: Chen, Shang-Xiong¹ 614232643@qq.com, Zhang, Bin¹, Hao, Ying-Xue¹, Xiao, Hang¹

المصدر: Angiology. Jul2024, Vol. 75 Issue 6, p556-564. 9p.

مصطلحات موضوعية: *LEG physiology, *PERIPHERAL vascular disease treatment, *RADIAL artery, *SURGERY, *PATIENTS, *RESEARCH funding, *PERIPHERAL vascular diseases, *INTRAVENOUS catheterization, *ENDOVASCULAR surgery, *TREATMENT effectiveness, *RETROSPECTIVE studies, *SURGICAL therapeutics, *DESCRIPTIVE statistics, *OPERATIVE surgery, *COMPARATIVE studies, *FEMORAL artery

مستخلص: This study compared the efficacy and safety of distal transradial access (dTRA) and common femoral artery access (CFA) for endovascular treatment of non-coronary arterial disease. 102 interventions were divided into dTRA (n = 51) and CFA (n = 51) groups; the puncture success rate was 100% in both groups. The mean number of punctures and puncture time were greater in the dTRA than CFA group (1.86 vs 1.04 and 3.96 vs ≤1.00 min, p <.001 for both), whereas the access-related complication rate was comparable. The surgical success rate was higher in the CFA than dTRA group (98.0 vs 84.3, p =.036), and the operative time was longer in the dTRA than CFA group (99.09 vs 84.10 min, p =.017). The postoperative adverse event rate was not different between the dTRA and CFA groups. dTRA is a safe and feasible access for non-coronary arterial disease and is comparable to CFA in terms of puncture success, access-related complications, and major adverse events. The dTRA is inferior to CFA in the treatment of lower extremity arterial disease. Due to the increase in the operation time and the contrast medium volume in the dTRA, it is necessary to be vigilant about contrast nephropathy and late radiological random side effects. [ABSTRACT FROM AUTHOR]

المؤلفون: Itagaki, Tadashi¹, Ebisawa, Soichiro² ebisawa@shinshu-u.ac.jp, Kato, Tamon², Miura, Takashi^1,3, Oyama, Yushi⁴, Hashizume, Naoto⁵, Yokota, Daisuke⁶, Taki, Minami⁵, Senda, Keisuke⁷, Okina, Yoshiteru², Wakabayashi, Tadamasa⁸, Fujimori, Kouki⁹, Karube, Kenichi¹⁰, Sakai, Takahiro¹¹, Nomoto, Fumika¹, Takamatsu, Toshifumi¹, Tanaka, Kiu¹, Mochidome, Tomoaki¹, Saigusa, Tatsuya², Motoki, Hirohiko²

المصدر: Angiology. Jul2024, Vol. 75 Issue 6, p536-545. 10p.

مصطلحات موضوعية: *PERIPHERAL vascular disease treatment, *PREDICTION models, *ENDOVASCULAR surgery, *TREATMENT effectiveness, *RESEARCH methodology, *INFLAMMATION, *COMPARATIVE studies

مستخلص: We assessed the prognostic ability of several inflammation-based scores and compared their long-term outcomes in patients with peripheral artery disease (PAD) following endovascular treatment (EVT). We included 278 patients with PAD who underwent EVT and classified them according to their inflammation-based scores (Glasgow prognostic score [GPS], modified GPS [mGPS], platelet to lymphocyte ratio [PLR], prognostic index [PI], and prognostic nutritional index [PNI]). Major adverse cardiovascular events (MACE) at 5 years were examined, and C-statistics in each measure were calculated to compare their MACE predictive ability. During the follow-up period, 96 patients experienced MACE. Kaplan–Meier analysis showed that higher scores of all measures were associated with a higher MACE incidence. Multivariate Cox proportional hazard analysis showed that GPS 2, mGPS 2, PLR 1, and PNI 1, compared with GPS 0, mGPS 0, PLR 0, and PNI 0, were associated with an increased risk of MACE. C-statistics for MACE for PNI (.683) were greater than those for GPS (.635, P =.021), mGPS (.580, P =.019), PLR (.604, P =.024), and PI (.553, P <.001). PNI is associated with MACE risk and has a better prognosis-predicting ability than other inflammation-scoring models for patients with PAD following EVT. [ABSTRACT FROM AUTHOR]

المؤلفون: Leisring, Joshua¹, Brodsky, Sergey V.¹, Parikh, Samir V.¹ Samir.parikh@osumc.edu

المصدر: Arthritis & Rheumatology. Feb2024, Vol. 76 Issue 2, p153-165. 13p.

مصطلحات موضوعية: *HEMOLYTIC anemia diagnosis, *PERIPHERAL vascular disease treatment, *THROMBOCYTOPENIA treatment, *HEMOLYTIC anemia treatment, *ENDOTHELIAL cells, *THROMBOTIC thrombocytopenic purpura, *THROMBOCYTOPENIA, *HEMOLYTIC-uremic syndrome, *SYMPTOMS, PERIPHERAL vascular disease diagnosis

مستخلص: Thrombotic microangiopathy (TMA) refers to a diverse group of diseases that share clinical and histopathologic features. TMA is clinically characterized by microangiopathic hemolytic anemia, consumptive thrombocytopenia, and organ injury that stems from endothelial damage and vascular occlusion. There are several disease states with distinct pathophysiological mechanisms that manifest as TMA. These conditions are associated with significant morbidity and mortality and require urgent recognition and treatment. Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome are traditionally considered to be primary forms of TMA, but TMA more commonly occurs in association with a coexisting condition such as infection, pregnancy, autoimmune disease, or malignant hypertension, among others. Determining the cause of TMA is a diagnostic challenge because of limited availability of disease-specific testing. However, identifying the underlying etiology is imperative as treatment strategies differ. Our understanding of the conditions that cause TMA is evolving. Recent advances have led to improved comprehension of the varying pathogenic mechanisms that drive TMA. Development of targeted therapeutics has resulted in significant improvements in patient outcomes. In this article, we review the pathogenesis and clinical features of the different TMA-causing conditions. We outline a practical approach to diagnosis and management and discuss empiric and disease-specific treatment strategies. [ABSTRACT FROM AUTHOR]

المؤلفون: Leandro, Daniela Luana Fernandes¹, D'Agostino, Fabio², Lopes, Camila Takao³, Lopes, Juliana de Lima³ julianalimalopes@gmail.com

المصدر: International Journal of Nursing Knowledge. Apr2024, Vol. 35 Issue 2, p107-116. 10p.

مصطلحات موضوعية: *INFECTION risk factors, *MEDICAL logic, *NURSES, *HUMAN services programs, *CHRONIC pain, *URINARY incontinence, *HOSPITAL nursing staff, *NURSING, *WALKING, *PAIN management, *ARTERIAL occlusions, *NURSING diagnosis, *DELPHI method, *EXPERTISE, *PERFUSION, *HUMAN comfort, *NURSING students, *CRITICAL thinking, *SENSITIVITY & specificity (Statistics), *ACCIDENTAL falls, *EVALUATION, PERIPHERAL vascular disease diagnosis, RESEARCH evaluation

مستخلص: Purpose: The aim of this study is to develop and validate a case study to aid in the diagnostic reasoning of nursing students and nurses. Methods: It is a validation study using a case study based on Lunney's method including (1) content validation of the case study by nurse experts through the Delphi technique, (2) identification of nursing diagnoses (NDs) in the case, (3) evaluation of diagnostic accuracy, and (4) establishment of a priority diagnosis by nurse experts. Findings: The case study was developed from the findings of a narrative literature review on the cues of the NDs with a prevalence > 50% in patients with peripheral arterial occlusive disease. Two rounds of expert evaluation were required to validate the case study. The experts identified 18 NDs with different degrees of accuracy. The highly accurate diagnoses most frequently identified by the experts were: Ineffective peripheral tissue perfusion (100%), impaired walking (83%), impaired comfort (50%), and chronic pain (50%). The diagnosis considered a priority by all experts was ineffective peripheral tissue perfusion. Conclusions: The case study was developed and had its content validated. High‐accuracy diagnoses were identified, and a priority was determined. Implications for Nursing Practice: The validated case study may be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in practice, teaching or research. [ABSTRACT FROM AUTHOR]

المؤلفون: Huang, Shu-Chun^1,2,3, Yeh, Chi-Hsiao^3,4, Hsu, Chih-Chin^3,5,6, Lin, Yu-Ching⁷, Lee, Chen-Hung^3,8, Hsiao, Ching-Chung^3,9, Chiu, Chien-Hung⁴, Fu, Tieh-Cheng^3,6 fic6481@gmail.com

المصدر: European Journal of Cardiovascular Nursing. Mar2024, Vol. 23 Issue 2, p127-136. 10p.

مصطلحات موضوعية: *PERIPHERAL vascular disease treatment, *HEART failure treatment, *STROKE treatment, *CARDIOPULMONARY fitness, *EXERCISE physiology, *OXYGEN saturation, *T-test (Statistics), *DATA analysis, *EXERCISE therapy, *QUESTIONNAIRES, *FISHER exact test, *RETROSPECTIVE studies, *HEALTH surveys, *MANN Whitney U Test, *DESCRIPTIVE statistics, *CARDIOPULMONARY system, *CARDIAC output, *ANKLE brachial index, *QUALITY of life, *RESEARCH, *AEROBIC exercises, *MAGNETIC resonance angiography, *ANALYSIS of variance, *ONE-way analysis of variance, *STATISTICS, *COMPARATIVE studies, *EXERCISE tests, *OXYGEN consumption, *PULSE wave analysis, *DATA analysis software

مستخلص: Aims In patients with peripheral arterial disease (PAD), exercise therapy is recommended to relieve leg symptoms, as noted in the 2016 AHA/ACC and 2017 ESC/ESVS guidelines. We assessed the trainability for cardiopulmonary fitness (CPF) and quality of life (QOL); three distinct patient types, namely, PAD, heart failure (HF), and stroke, were compared. Methods and results This is a multicentre, retrospective analysis of prospectively collected data from three clinical studies. Data collected from 123 patients who completed 36 sessions of supervised aerobic training of moderate intensity were analysed, with 28 PAD, 55 HF, and 40 stroke patients totalling 123. Before and after training, cardiopulmonary exercise testing with non-invasive cardiac output monitoring and QOL evaluation using a 36-Item Short Form Survey (SF-36) were performed. Non-response was defined as a negative change in the post-training value compared with that in the pre-training value. The result showed an improvement in CPF in all three groups. However, cardiorespiratory fitness (CRF) increased by a lesser extent in the PAD group than in the HF and stroke groups; the physical and mental component scores (MCS) of SF-36 exhibited a similar pattern. Non-response rates of peak V ˙ O 2 ⁠ , oxygen uptake efficiency slope, and MCS were higher in the PAD group. In the PAD group, non-responders regarding peak V ˙ O 2 had a higher pulse wave velocity than responders. Conclusion In patients with PAD following exercise therapy, CRF and QOL improved to a lesser extent on average; their non-response rate was also higher compared with that of HF or stroke patients. Therefore, a higher dose of exercise might be needed to elicit adaptation in PAD patients, especially those with high pulse wave velocity. [ABSTRACT FROM AUTHOR]

المؤلفون: Konda, Vishnu Vardhan Reddy¹, Jindal, Ankur Kumar¹ ankurjindal11@gmail.com, Nadig, Pallavi L¹, Banday, Aaqib Zaffar¹, Vinay, Keshavamurthy², Singh, Surjit¹

المصدر: Rheumatology. Feb2024, Vol. 63 Issue 2, p392-398. 7p.

مصطلحات موضوعية: *STATISTICS, *CAPILLARIES, *ANGIOSCOPY, *CASE-control method, *MANN Whitney U Test, *RISK assessment, *PEARSON correlation (Statistics), *DESCRIPTIVE statistics, *MUCOCUTANEOUS lymph node syndrome, *VASCULAR diseases, *DATA analysis software, *DATA analysis, *LONGITUDINAL method, *DISEASE risk factors, *DISEASE complications, VASCULAR disease diagnosis

مستخلص: Objectives Kawasaki disease (KD) is a medium vessel vasculitis with a predilection to involve coronary arteries. However, there is a paucity of literature on microvascular changes in patients with KD. Methods Children diagnosed with KD based on American Heart Association guidelines 2017 were enrolled prospectively. Demographic details and echocardiographic changes in coronaries were recorded. Nailfold capillaries were assessed using Optilia Video capillaroscopy and data were analysed using Optilia Optiflix Capillaroscopy software at acute (prior to IVIG administration) and subacute/convalescent phase. Results We enrolled 32 children with KD (17 boys) with a median age of 3 years. Nailfold capillaroscopy (NFC) was performed in 32 patients in the acute phase (compared with 32 controls) and in 17 during the subacute/convalescent phase at a median follow-up of 15 (15–90) days after IVIG treatment. The following findings were seen in NFC in the acute phase of KD: reduced capillary density (n  = 12, 38.6%), dilated capillaries (n  = 3, 9.3%), ramifications (n  = 3, 9.3%) and capillary haemorrhages (n  = 2, 6.2%). Capillary density was reduced significantly in the acute phase of KD (38.6%) as compared with the subacute/convalescent phase (25.4%) (P -value <0.001) and controls (0%) (P -value = 0.03). We observed no correlation between coronary artery involvement and mean capillary density (P  = 0.870). Conclusion Results show that patients with KD have significant nailfold capillary changes in the acute phase. These findings may provide a new diagnostic paradigm for KD and a window to predict coronary artery abnormalities. [ABSTRACT FROM AUTHOR]

المؤلفون: Aramburo Caragol, Angela

مرشدي الرسالة: Rodrigo Gonzalo de Liria, Carlos

المصدر: TDX (Tesis Doctorals en Xarxa)

مصطلحات موضوعية: Cardiopatia congènita, Cardiopatía congénita, Congenital heart defect, Malaltia vascular pulmonar, Enfermedad vascular pulmonar, Pulmonary vascular disease, Carnitina, Carnitine, Ciències de la Salut

الوصف: Les cardiopaties congènites que cursen amb hiperaflux pulmonar resulten en una disfunció endotelial progressiva de la vasculatura pulmonar, que en part és dependent d’una disminució en la via de senyalització de l’òxid nítric (NO). En un model animal oví de cardiopatia congènita amb hiperafluxe pulmonar hem demostrat prèviament una disrupció en l’homeòstasis de la carnitina, que s’associa a disfunció mitocondrial i que contribueix tant al desacoblament de la sintassa d’òxid nítric endotelial (eNOS) com a una reducció del NO disponible. Aquest projecte de tesi doctoral té com a objectiu testar la hipòtesi que el tractament precoç amb L-carnitina mantindrà l’homeòstasis de la carnitina, la funció mitocondrial i la senyalització del NO en un model animal oví de cardiopatia congènita amb hiperaflux pulmonar. Mètodes: En l’última fase de la gestació, es va inserir intra-úter una comunicació aorto-pulmonar en 13 fetus de bens. Després d’un part espontani, els xais van rebre tractament diari amb L-carnitina (n = 7; 100 mg / kg / dia) o el seu vehicle (n = 6). Un grup addicional d’11 xais amb flux pulmonar normal va servir de control. Resultats: En comparació als xais amb hiperaflux pulmonar tractats amb vehicle, els xais tractats amb L-carnitina van presentar a les 4 setmanes d’edat postnatal una disminució en els nivells d’acilcarnitina i en la raó acilcarnitina/carnitina lliure. Aquests canvis es van correlacionar amb un augment en els nivells i en l’activitat de l’enzim carnitina acetiltransferasa (CRAT), alhora que amb una disminució dels nivells de CRAT nitrada i de la raó làctic/pirúvic. A més, els xais tractats amb carnitina van presentar una reducció significativa dels nivells de la proteïna Hsp70, en correlació amb un augment de les interaccions eNOS/Hsp90, de l’activitat NOS i dels nivells NOx, a la vegada que amb una disminució dels nivells de superòxid derivat d’eNOS. Finalment, l’administració d’acetilcolina va disminuir significativament la resistència pulmonar vascular esquerra només en els xais tractats amb L-carnitina. Conclusions: El tractament precoç amb L-carnitina pot millorar i/o atenuar el declivi de la funció endotelial que caracteritza els nens amb cardiopaties congènites associades a hiperaflux pulmonar, amb potencials implicacions clíniques rellevants que justifiquen continuar investigant.

الوصف (مترجم): Las cardiopatías congénitas que cursan con hiperaflujo pulmonar resultan en una disfunción endotelial progresiva de la vasculatura pulmonar, que en parte es dependiente de una disminución en la vía de señalización del óxido nítrico (NO). En un modelo animal ovino de cardiopatía congénita con hiperaflujo pulmonar, hemos demostrado previamente una disrupción en la homeostasis de la carnitina, que se asocia a una disfunción mitocondrial i que contribuye tanto al desacoplamiento de la sintasa del óxido nítrico endotelial (eNOS) como a una reducción del NO disponible. Este proyecto de tesis doctoral tiene como objectivo testar la hipótesis de que el tratamiento precoz con L-carnitina mantendrá la homeostasis de la carnitina, la función mitocondrial y la señalización del NO en un modelo animal ovino de cardiopatía congénita con hiperaflujo pulmonar. Métodos: En la última fase de la gestación, se insertó intra-útero una comunicación aorto-pulmonar en 13 fetos de corderos. Tras un parto espontáneo, los corderos recibieron tratamiento diario con L-carnitina (n=7; 100 mg/kg/día) o su vehículo (n=6). Un grupo adicional de 11 corderos con flujo pulmonar normal sirvió de control. Resultados: En comparación a los corderos con hiperaflujo pulmonar tratados con vehículo, los corderos tratados con L-carnitina presentaron a las 4 semanas de edad post-natal una disminución en los niveles de acilcarnitina y en la razón de acil-carnitine/carnitina libre. Estos cambios se correlacionaron con un aumento en los niveles y en la actividad de la enzima carnitina acetil-transferasa (CrAT), a la vez que con una disminución de los niveles de CrAT nitrada y de la razón láctico/pirúvico. Además, los corderos tratados con L-carnitina presentaron una reducción significativa de los niveles de la proteína Hsp70, en correlación con un aumento de las interacciones eNOS/Hsp90, de la actividad NOS y de los niveles NOx, a la vez que con una disminución de los niveles de superóxido derivado de eNOS. Por último, la administración de acetilcolina disminuyó significativamente la resistencia pulmonar vascular izquierda solo en los corderos tratados con L-carnitina. Conclusiones: El tratamiento precoz con L-carnitina puede mejorar y/o atenuar el declive de la función endotelial que caracteriza a los niños con cardiopatías congénitas asociadas a hiperaflujo pulmonar, con potenciales implicaciones clínicas relevantes que justifican continuar investigando.
Congenital heart disease (CHD) with increased pulmonary blood flow (PBF) results in a progressive pulmonary vascular endothelial dysfunction that is partly dependent on decreased nitric oxide (NO) signaling. In a lamb model of CHD with increased PBF, we have previously shown a disruption in carnitine homeostasis, associated with mitochondrial dysfunction that contributes to eNOS uncoupling and decreased bioavailable NO. This study aims to test the hypothesis that Lcarnitine therapy would maintain carnitine homeostasis, mitochondrial function and NO signaling in our lamb model of increased PBF. Methods: 13 fetal lambs underwent in-utero placement of an aorto-pulmonary graft (shunt). Immediately following spontaneous delivery, lambs received daily treatment with oral L-carnitine (n=7; 100 mg/kg/day) or its vehicle (n=6). An additional group of eleven lambs with normal PBF served as controls. Results: At 4-weeks of age, L-carnitine-treated shunt lambs had decreased levels of acylcarnitine and a reduced acylcarnitine/free carnitine ratio compared to vehicle-treated shunt lambs. These changes correlated with increased carnitine acetyl-transferase (CrAT) protein and enzyme activity, as well as decreased levels of nitrated CrAT. The lactate/pyruvate ratio was also decreased in L-carnitine-treated shunt lambs. Furthermore, Hsp70 protein levels were significantly decreased in L-carnitine-treated shunt lambs, which correlated with a significant increase in eNOS/Hsp90 interactions, NOS activity, and NOx levels, as well as with a significant decrease in eNOS derived superoxide. Further, acetylcholine significantly decreased left pulmonary vascular resistance (PVR) only in L-carnitine-treated shunt lambs. Conclusions: Early L-carnitine therapy may improve and/or attenuate the decline in endothelial function noted in children with CHD associated with pulmonary overflow, and thus has potentially important clinical implications that warrant further investigation.
Universitat Autònoma de Barcelona. Programa de Doctorat en Pediatria, Obstetrícia i Ginecologia

وصف الملف: application/pdf

الوصول الحر: http://hdl.handle.net/10803/672053Test

المؤلفون: Grant, Cori¹ cgrant@amga.org, Cuddeback, John K.¹, Alabi, Olamide², Hicks, Caitlin W.³, Sadik, Kay⁴, Ciemins, Elizabeth L.¹

المصدر: Population Health Management. Dec2023, Vol. 26 Issue 6, p387-396. 10p.

مصطلحات موضوعية: *PERIPHERAL vascular disease treatment, *MEDICAL quality control, *GENERAL practitioners, *OCCUPATIONAL roles, *SOCIAL determinants of health, *PERIPHERAL vascular diseases, *RESEARCH methodology, *INTERVIEWING, *LEG, *QUALITATIVE research, *HEALTH insurance reimbursement, *VALUE-based healthcare, *RESPONSIBILITY, *MEDICAL protocols, *PSYCHOSOCIAL factors, *MEDICAL referrals, *HEALTH care teams, *DESCRIPTIVE statistics, *RESEARCH funding, *HEALTH equity, *THEMATIC analysis, *POPULATION health, *PHYSICIANS, *PATIENT education, *EARLY diagnosis, *TELEMEDICINE, PERIPHERAL vascular disease diagnosis

مستخلص: Lower-extremity peripheral artery disease (PAD), the accumulation of atherosclerotic plaque in the arteries of the legs, causes substantial morbidity and mortality. Frequent under- and delayed diagnosis result in poor outcomes, disproportionately affecting individuals from racial and ethnic minority groups. To understand barriers to early detection and treatment and factors contributing to disparities, American Medical Group Association (AMGA) conducted roundtable discussions and semistructured interviews in 2021. Eighteen participants discussed PAD evaluation, diagnosis, early medical management, and disparities in care. A qualitative case study approach and data reduction methods were used to generate themes, draw conclusions, and make actionable recommendations. Identified themes included lack of (1) prioritization of PAD for population health; (2) engagement of primary care providers in early evaluation and referral; (3) "ownership" of lower-extremity PAD within health systems; and (4) focus on disparities in care. Participant solutions included (1) financial impact of early PAD management, in the context of value-based payment; (2) embedding an advanced practice provider into a vascular surgery practice to facilitate evaluation and provide medical therapy; and (3) leveraging care coordination, multidisciplinary clinics, and telehealth technology to provide comprehensive care for patients with PAD and address disparities. A deliberate focused effort is necessary to close gaps and the accompanying disparities in early evaluation, diagnosis, and treatment for people with lower-extremity PAD. The authors describe 3 models that can be emulated to improve care for this high-risk population. With improved reimbursement and better medical therapies, now is the time to focus on early diagnosis and management of PAD. [ABSTRACT FROM AUTHOR]