Abstract
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Highlights
This document supersedes recommendations related to lower extremity peripheral artery disease (PAD) in the “ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease”[9] and the “2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease.”[10]. The scope of this guideline is limited to atherosclerotic disease of the lower extremity arteries (PAD) and includes disease of the aortoiliac, femoropopliteal, and infrapopliteal arterial segments
Physical activity has been shown to be associated with improvement in functional status in patients with asymptomatic PAD,[93,94] the benefit of resting ankle-brachial index (ABI) testing to identify asymptomatic patients who are at increased risk of functional decline and may benefit from structured exercise programs remains to be determined
Patients with PAD have been shown to have increased plasma homocysteine levels compared with patients without PAD, there is no evidence that B-complex vitamin supplementation improves clinical outcomes in patients with PAD.[207]
Summary
The recommendations listed in this guideline are, whenever possible, evidence based. An initial extensive evidence review, which included literature derived from e728 March 21, 2017. All other guideline recommendations (not based on the systematic review questions) were subjected to an extensive evidence review process. The writing committee in conjunction with the Task Force and ERC Chair identified the following systematic review questions: 1) Is antiplatelet therapy beneficial for prevention of cardiovascular events in the patient with symptomatic or asymptomatic lower extremity PAD? This question had been the subject of a high-quality systematic review that synthesized evidence from observational data and an RCT14; additional RCTs addressing this question are ongoing.[15,16,17] The writing committee and the Task Force decided to expand the survey to include more relevant randomized and observational studies.
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