Updated guideline released on PAD diagnosis and management

An updated guideline on diagnosis and management of peripheral artery disease (PAD) was released last week by the American College of Cardiology Foundation and the American Heart Association, in conjunction with several other medical organizations.

The guideline, which updates 2005 recommendations on the subject, expands criteria for using the ankle-brachial index (ABI), recommends increased efforts to ensure access to smoking cessation services, encourages improved antiplatelet and antithrombotic therapy, and more precisely defines interventions to avoid limb amputation and to treat aortic aneurysms. Specific recommendations include:

• The ABI should first be performed in patients 65 years of age or older, compared with 70 years of age or older according to the 2005 guideline;
• Current and former smokers should be asked about tobacco use at each visit and should be proactively offered support to help them quit, such as counseling, pharmacologic therapies and/or formal smoking cessation programs;
• Aspirin plus clopidogrel may be considered in patients with symptomatic atherosclerotic lower-extremity PAD to reduce risk for cardiovascular events;
• Balloon angioplasty is a reasonable first-line treatment for patients with severe PAD who may need amputation and are expected to live for two years or less. For those expected to live more than two years, bypass surgery is a reasonable option; and
• Open repair for abdominal aortic aneurysms is reasonable in patients who are good candidates for surgery but can't comply with periodic long-term surveillance after endovascular repair.

The guideline was developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. It was published online Sept. 29 by the Journal of the American College of Cardiology and Circulation.