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Updated guideline outlines recommendations for PAD diagnosis, management
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The American College of Cardiology Foundation, American Heart Association and other collaborating societies have released an updated guideline for the diagnosis and management of patients with peripheral artery disease.
“While there have been progressive improvements in PAD care, it appears that even simple ‘intervention,’ like appropriate prescription of smoking cessation and exercise, are not utilized by clinicians, health care systems and payers. We still have a long way to go; the opportunity for prevention and earlier, life-saving interventions is immense. This guideline provides a road map,” Alan Hirsch, MD, professor of medicine, epidemiology and community health in the Lillehei Heart Institute and Cardiovascular Division at the University of Minnesota Medical School, said in a press release.
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Notable updates
One focus of the guideline is expanded criteria for using the ankle-brachial index (ABI) for earlier diagnosis. The experts recommend lowering the age at which ABI diagnostic testing should be performed in the practice setting from aged 70 years or older to 65 years or older. This decision was based on mounting evidence demonstrating that people aged 65 years and older have a one in five chance of having either symptomatic or asymptomatic PAD.
“Age alone appears to define a patient population at such a high risk of PAD that we can justify using a cost-effective and risk-free test like the ABI,” Thom Rooke, MD, Krehbiel professor of vascular medicine, Mayo Clinic, Rochester, Minn., said in the press release.
Smoking cessation and 325 mg aspirin per day are suggested for patients with lower-extremity PAD. Specific recommendations include consistently asking current and former smokers about tobacco use at each visit, as well as proactively offering support through counseling, pharmacologic therapies and/or formal smoking cessation programs.
Leg artery angioplasty is the first-line treatment for carefully selected patients in order to prolong amputation-free survival and overall survival. Because angioplasty does not provide an ideal treatment for all patients with PAD, for those in whom a lifespan greater than 2 years is anticipated, open vascular surgery may be more durable and most effective, according to the guideline.
Additionally, open or endovascular intervention is recommended for patients with infrarenal abdominal aortic aneurysm. The guideline focused on new data showing that aortic aneurysms can be safely treated by both methods with nearly equal efficacy and safety.
Goal to improve patient care
“This document provides agreed-upon approaches and treatments for PAD that vascular surgeons, vascular medicine specialists, cardiologists, pulmonologists, interventional radiologists and primary care clinicians can apply to help improve patient care,” Rooke stated in the release. “This guideline is especially important for PAD, which is often still treated less aggressively than heart disease, and we know that many patients do not yet receive ideal care.”
Rooke T. J Am Coll Cardiol. 2011;doi:10.1016/j.jacc.2011.08.023.
Disclosure: Writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply.
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