Enhance integrated pathway management for lower extremity atherosclerotic disease: improve treatment outcomes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHEN Zhong

Vascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding?author：

CHEN Zhong, Email: chenzhong8658@vip.sina.com

Keywords：

lower extremity atherosclerotic disease; diagnosis; treatment; integrated pathway management

DOI：

10.7507/1007-9424.202601069

Video：

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Lower extremity atherosclerotic disease (LEAD) is one of the serious chronic diseases globally. In recent years, medical advancements have led to significant progress in LEAD treatment, yet certain challenges remain. Within the diagnostic and therapeutic process for LEAD, a shift from the traditional open surgical model to an endovascular treatment approach has yielded marked success. However, it is necessary to guard against an oversimplified diagnostic and therapeutic mindset. Personalized diagnosis and treatment should be administered based on the patient’s condition and the nature of the lesions. In real-world practice, there is often a disproportionate emphasis on revascularization procedures, overlooking comprehensive assessment and holistic management. Consequently, a recent trend has emerged, shifting the focus from mere revascularization to integrated, full-process management. This paper provides a comprehensive exposition on preoperative diagnosis and holistic assessment, the rational selection of primary treatment methods and surgical techniques, and the optimization of treatment strategies across the full life cycle, while underscoring the importance of whole-process management. It further explores the implications of this transition and its potential for future development.

Citation： CHEN Zhong. Enhance integrated pathway management for lower extremity atherosclerotic disease: improve treatment outcomes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(1): 11-15. doi: 10.7507/1007-9424.202601069 Copy

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5.	Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg, 2019, 69(6S): 3S-125S. e40. doi: 10.1016/j.jvs.2019.02.016.
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9.	Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2024, 149(24): e1313-e1410. doi: 10.1161/CIR.0000000000001251.
10.	Fischer UM, Shireman PK, Lin JC. Current applications of artificial intelligence in vascular surgery. Semin Vasc Surg, 2021, 34(4): 268-271.
11.	Flores AM, Demsas F, Leeper NJ, et al. Leveraging machine learning and artificial intelligence to improve peripheral artery disease detection, treatment, and outcomes. Circ Res, 2021, 128(12): 1833-1850.
12.	McBane RD, Murphree DH, Liedl D, et al. Artificial intelligence of arterial doppler waveforms to predict major adverse outcomes among patients evaluated for peripheral artery disease. J Am Heart Assoc, 2024, 13(3): e031880. doi: 10.1161/JAHA.123.031880.

1. Bradbury AW, Moakes CA, Popplewell M, et al. A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial. Lancet, 2023, 401(10390): 1798-1809.
2. 中華醫學會外科學分會血管外科學組, 中國醫師協會血管外科醫師分會, 陳忠, 等. 下肢動脈疾病腔內減容規范化應用中國專家共識(2024版). 中國實用外科雜志, 2024, 44(12): 1328-1338.
3. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASCⅡ). J Vasc Surg, 2007, 45 Suppl S: S5-S67. doi: 10.1016/j.jvs.2006.12.037.
4. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
5. Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg, 2019, 69(6S): 3S-125S. e40. doi: 10.1016/j.jvs.2019.02.016.
6. Conte MS, Bandyk DF, Clowes AW, et al. Results of PREVENT Ⅲ: a multicenter, randomized trial of edifoligide for the prevention of vein graft failure in lower extremity bypass surgery. J Vasc Surg, 2006, 43(4): 742-751.
7. Dick F, Ricco JB, Davies AH, et al. Chapter Ⅵ: follow-up after revascularisation. Eur J Vasc Endovasc Surg. 2011, 42 Suppl 2: S75-S90. doi: 10.1016/S1078-5884(11)60013-0.
8. Yates TE, Madassery S. Post-revascularization management // Limb preservation for the vascular specialist: from wound care to wound closure. Madassery S, Patel A. Cham: Springer International Publishing, 2023: 283-291.
9. Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2024, 149(24): e1313-e1410. doi: 10.1161/CIR.0000000000001251.
10. Fischer UM, Shireman PK, Lin JC. Current applications of artificial intelligence in vascular surgery. Semin Vasc Surg, 2021, 34(4): 268-271.
11. Flores AM, Demsas F, Leeper NJ, et al. Leveraging machine learning and artificial intelligence to improve peripheral artery disease detection, treatment, and outcomes. Circ Res, 2021, 128(12): 1833-1850.
12. McBane RD, Murphree DH, Liedl D, et al. Artificial intelligence of arterial doppler waveforms to predict major adverse outcomes among patients evaluated for peripheral artery disease. J Am Heart Assoc, 2024, 13(3): e031880. doi: 10.1161/JAHA.123.031880.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Enhance integrated pathway management for lower extremity atherosclerotic disease: improve treatment outcomes

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