Consensus recommendations for essential vascular care in low- and middle-income countries

Barclay T. Stewart*, Adam Gyedu, Christos Giannou, Brijesh Mishra, Norman Rich, Sherry M. Wren, Charles Mock, Adam L. Kushner, Barclay T. Stewart*, Adam Gyedu, Phillip Alexander, Forster Amponsah-Manu, Alan Dardik, Nii Daako Darko, Eric Elster, Christos Giannou, Mark J. Harris, Lily Johnston, Scott Junkins, Collins KokuroDavid Kuwayama, Wilfed Labi-Addo, Brijesh Mishra, Martin Morna, Victor Oppong-Nketia, Sergelen Orgoi, Elina Quiroga, Kyle Remick, Nigel Tai, Martin Veller, Herve Yangi-Angate, Norman Rich, Charles Mock, Adam L. Kushner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objective Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. Methods The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health as well as with experience in LMIC health care. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. Results The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs, comprising primary health centers and first-level, referral, and tertiary hospitals. The recommendations include essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. Conclusions The resources recommended have the potential to improve the ability of LMIC health care systems to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization, without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning prehospital and interhospital transport system, and vascular training for existing and future health care providers.

Original languageEnglish
Pages (from-to)1770-1779.e1
JournalJournal of Vascular Surgery
Issue number6
StatePublished - 1 Dec 2016


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