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<p>Recent peripheral artery disease (PAD) guidelines define four types of PAD, including masked PAD, which requires an active investigation, particularly in geriatric and wound patients, in order to minimize the unchanged high number of amputations. Vascular diagnostics and revascularization in case of ischemic reasons should be carried out before every amputation. Structured or guided walking exercise is the primary therapy for chronic symptomatic PAD and mandatory after every revascularization. The updated guideline on thrombosis and pulmonary embolism provides practical recommendations, including the thrombosis traffic light as a&#xa0;decision-making aid for the pros and cons of prolonged anticoagulation therapy. Compression therapy started as soon as a&#xa0;deep vein thrombosis is diagnosed prevents every second postthrombotic syndrome. Regardless of the extent of the thrombosis, knee-length compression is sufficient. Compression is also possible for noncritical PAD, neuropathy and erysipelas. Manual lymphatic drainage without compression therapy is pointless and not justifiable from a&#xa0;health economic point of view. Lipedema should only be diagnosed if there is a&#xa0;disproportion between a&#xa0;slim trunk and circumferentially enlarged legs in conjunction with painful fatty tissue in the extremities. Lipedema neither affects the trunk nor the abdomen and it excludes the feet. Every wound should be assessed in a&#xa0;structured manner for arterial, venolymphatic and neuropathic causes, as only a&#xa0;causal therapy will enable the healing of the wounds: arterial wounds require revascularization, congestion-related venolymphatic wounds require effective compression and neuropathic pressure-related wounds require consistent offloading.</p>

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Angiologie und Wundmanagement

  • 期刊论文

  • 发表日期：

    2025年6月26日

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  • Katja S. Mühlberg

摘要

Recent peripheral artery disease (PAD) guidelines define four types of PAD, including masked PAD, which requires an active investigation, particularly in geriatric and wound patients, in order to minimize the unchanged high number of amputations. Vascular diagnostics and revascularization in case of ischemic reasons should be carried out before every amputation. Structured or guided walking exercise is the primary therapy for chronic symptomatic PAD and mandatory after every revascularization. The updated guideline on thrombosis and pulmonary embolism provides practical recommendations, including the thrombosis traffic light as a decision-making aid for the pros and cons of prolonged anticoagulation therapy. Compression therapy started as soon as a deep vein thrombosis is diagnosed prevents every second postthrombotic syndrome. Regardless of the extent of the thrombosis, knee-length compression is sufficient. Compression is also possible for noncritical PAD, neuropathy and erysipelas. Manual lymphatic drainage without compression therapy is pointless and not justifiable from a health economic point of view. Lipedema should only be diagnosed if there is a disproportion between a slim trunk and circumferentially enlarged legs in conjunction with painful fatty tissue in the extremities. Lipedema neither affects the trunk nor the abdomen and it excludes the feet. Every wound should be assessed in a structured manner for arterial, venolymphatic and neuropathic causes, as only a causal therapy will enable the healing of the wounds: arterial wounds require revascularization, congestion-related venolymphatic wounds require effective compression and neuropathic pressure-related wounds require consistent offloading.