J Am Coll Cardiol

ACC/AHA lower extremity peripheral artery disease guideline update—What’s new?

May 28, 2024

Guideline updates cover 4 clinical subsets of PAD as well as new guidance on comprehensive care for PAD patients.

Key Points

• In addition to functional impairment and walking performance, PAD is linked with increased risk for MI, stroke, amputation, and death.
• 4 clinical subsets: asymptomatic, chronic symptomatic PAD (eg, claudication), chronic limb-threatening ischemia, acute limb ischemia.
• In most patients, PAD diagnosis is clinical, through history, exam, and resting ankle-brachial index.
• Medical therapy includes antiplatelet treatment (typically single-agent) and antithrombotic therapy, lipid-lowering and antihypertensive therapy, as well as diabetes management and smoking cessation. Rivaroxaban (2.5 mg PO bid) plus low-dose aspirin (81 mg PO daily) are effective to prevent cardiovascular and limb adverse events in PAD patients who aren’t at increased bleeding risk.
• Structured exercise is key, including supervised, community-based, and home-based programs.
• Revascularization, whether endovascular, surgical, or hybrid, is used to prevent limb loss in chronic limb-threatening ischemia, and can improve quality of life and function in patients with claudication that is not responding to medical therapy, plus structured exercise.
• Coordinated care is important; health disparities are linked to limb and CVr outcomes. Optimal care is delivered by a multi-specialty care team. Foot care is vital for PAD patients, including preventive care and education. Podiatrists and other experts in foot care, wound-healing, and foot surgery are key team members.

Source:

Writing Committee Members; Gornik HL, et al. (2024, May 14). J Am Coll Cardiol. 2024 ACC/AHA/AACVPR/APMAi/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. https://pubmed.ncbi.nlm.nih.gov/38752899/