New PAD Guidelines

New Clinical Guidelines for Peripheral Arterial Disease

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The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have just released an updated guideline for the diagnosis and management of peripheral arterial disease (PAD). The guideline includes the following:

  • A recommendation to lower the age at which ABI diagnostic testing should be performed in the practice setting from 70 years of age to 65 years of age
  • Increased efforts to ensure all patients have access to smoking cessation services
  • Improved use of clot-preventing medications
  • A more focused definition of effective interventions for avoiding limb amputations and treating aortic aneurysms

Peripheral arterial disease is a condition that affects tens of millions of Americans and can restrict blood flow to the legs, kidneys, or other vital organs. PAD, which is often underdiagnosed, is often a sign of a more widespread accumulation of fatty deposits in the heart, brain, or leg. If untreated, PAD is one of the most common causes of preventable heart attack, stroke, leg amputations, and death.

PAD restricts blood flow to the extremities, especially the legs and feet. When blood flow is reduced to the legs, walking may become difficult and painful, and amputation can occur. Decreased kidney blood flow can cause high blood pressure or kidney failure. Aneurysms of the aorta, the largest artery, can rupture and lead to death. According to the authors of the guidelines, PAD is often still treated less aggressively than heart disease and many patients don’t receive ideal care.

Some of the other recommendations set forth by the writing group include—

  • Strengthening efforts to help individuals with PAD quit smoking and, in turn, lower rates of heart attack, stroke, and lower limb amputations; this includes 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.
  • Considering leg artery angioplasty as a first line treatment for certain individuals with severe PAD who may face amputation. Because angioplasty does not provide an ideal treatment for all patients with PAD, for those in whom a lifespan greater than two years is anticipated, open (traditional) vascular surgery may be more durable and most effective.
  • Understanding new data showing that aortic aneurysms can be safely treated by both traditional open surgical and less invasive endovascular (catheter-based) treatments with nearly equal efficacy and safety.

The ACCF/AHA guideline, which updates the original 2005 recommendations, was developed in collaboration with representatives from the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery.

Published October 11, 2011

Source: Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral arterial disease (updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines [published online ahead of print September 29, 2011]. Circulation. 2011 Nov 1;124(18):2020-2045.