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Essential Vascular Surgical Care in Low and Middle Income Countries: Towards the Tipping Point

Open ArchivePublished:August 19, 2020DOI:https://doi.org/10.1016/j.ejvs.2020.08.004
      We read with great interest Prendes et al.’ s commentary
      • Prendes C.F.
      • Del Castro Madrazo J.A.
      Outcomes of lower limb revascularisation in low and middle income countries.
      on lower limb revascularisation in low and middle income countries (LMICs). It has become increasingly apparent that the burden of vascular diseases disproportionally affects vulnerable and LMIC populations as a result of the epidemiological transition away from infectious diseases and towards non-communicable diseases, as a result of the rise in smoking, air pollution, obesity, diabetes, and trauma.
      • Stewart B.T.
      • Gyedu A.
      • Giannou C.
      • Mishra B.
      • Rich N.
      • Wren S.M.
      • et al.
      Consensus recommendations for essential vascular care in low- and middle-income countries.
      Access to emergency and essential vascular surgical care, however, is grossly lacking in LMICs.
      • Meara J.G.
      • Leather A.J.M.
      • Hagander L.
      • Alkire B.C.
      • Alonso N.
      • Ameh E.A.
      • et al.
      Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.
      The resource constraints in rural or LMIC centres and local variation in vascular disease burden requires context appropriate guidelines informed by local practices, pathophysiology, and care accessibility. Efforts have been made to propose comprehensive guidelines for essential vascular care in LMICs
      • Stewart B.T.
      • Gyedu A.
      • Giannou C.
      • Mishra B.
      • Rich N.
      • Wren S.M.
      • et al.
      Consensus recommendations for essential vascular care in low- and middle-income countries.
      ; however, the paucity of data majorly impedes further advancement of comprehensive vascular care in LMICs, especially for non-traumatic vascular disease.
      The lack of data is, at least in part, driven by limited attention by the academic vascular community.
      • Ma X.
      • Miranda E.
      • Vervoort D.
      Placing equity at the core of vascular Surgery research.
      A recognition of the global surgical momentum by the vascular community will be essential to catalyse sustainable change, informed by data driven evidence, bilateral academic partnerships, and equitable practices. Now is the time to move towards the global vascular surgical tipping point to ensure that no patient is left behind.

      References

        • Prendes C.F.
        • Del Castro Madrazo J.A.
        Outcomes of lower limb revascularisation in low and middle income countries.
        Eur J Vasc Endovasc Surg. 2020; 60: 567
        • Stewart B.T.
        • Gyedu A.
        • Giannou C.
        • Mishra B.
        • Rich N.
        • Wren S.M.
        • et al.
        Consensus recommendations for essential vascular care in low- and middle-income countries.
        J Vasc Surg. 2016; 64 (e1): 1770-1779
        • Meara J.G.
        • Leather A.J.M.
        • Hagander L.
        • Alkire B.C.
        • Alonso N.
        • Ameh E.A.
        • et al.
        Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development.
        Lancet. 2015; 386: 569-624
        • Ma X.
        • Miranda E.
        • Vervoort D.
        Placing equity at the core of vascular Surgery research.
        J Vasc Surg. 2020; ([In Press])

      Linked Article

      • Outcomes of Lower Limb Revascularisation in Low and Middle Income Countries
        European Journal of Vascular and Endovascular SurgeryVol. 60Issue 4
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          Wijeyaratne et al. report outcomes of 367 patients undergoing lower extremity bypass for chronic limb threatening ischaemia (CLTI) in a university hospital in Sri Lanka.1 More than 202 million people are currently affected by peripheral arterial disease (PAD) worldwide.2 A 23.5% global increase was observed between 2000 and 2010, with a strikingly higher relative increase of PAD death rates and disability adjusted life years in low and middle income countries (LMICs) vs. high income countries.3
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