Recent guidelines on the diagnosis and treatment of peripheral arterial disease (PAD) published in the European Heart Journal provide an updated resource with available evidence on diagnosis and management strategies for extracranial carotid and vertebral artery disease, mesenteric artery disease, multisite artery disease, and renal artery disease, among several other types of PAD.
According to the 2017 guidelines developed by the European Society of Cardiology (ESC) and the European Society for Vascular Surgery (ESVS), the optimal management approaches for PAD are categorized into 2 important aspects. First, symptoms of any localization as well as any risk associated with a specific lesion should be addressed immediately. Second, the prevention of a cardiovascular event is essential for improving outcomes. Prevention involves pharmacologic therapy (eg, antihypertensive and antithrombotic medications and lipid-lowering drugs) as well as nonpharmacologic measures (eg, smoking cessation, weight loss, nutrition).
The new guidelines also present several gaps in evidence in the management of PAD. According to the investigators, clinical practice has attempted to match the rapid changes in therapeutic techniques without evidence from randomized controlled trials.
In addition, the investigators noted that many randomized clinical trials on the treatment of PAD present conflicting results because of rapid technical development and this further contributes to “the broad spectrum of gaps in evidence.”
According to The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the ESC and ESVS, multidisciplinary management of patients with PAD is an important aspect of treatment. In addition, the ESC and ESVS note that the practicing cardiologist “should be sensitive in regard to the diagnosis and management of patients with PADs, as many of them are seen and managed for concomitant cardiac conditions.”
Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS) [published online August 26, 2017]. Eur Heart J. doi:10.1093/eurheartj/ehx095