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]

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Summary

Methodology and Evidence Review

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.

Organization of the Writing Committee
Document Review and Approval
Scope of Guideline
History and Physical Examination
Resting ABI for Diagnosing PAD
III: No Benefit
Physiological Testing
Imaging for Anatomic Assessment
Abdominal Aortic Aneurysm
MEDICAL THERAPY FOR THE PATIENT WITH PAD
Antiplatelet Agents
Statin Agents
Antihypertensive Agents
Smoking Cessation
Glycemic Control
Oral Anticoagulation
Cilostazol
Pentoxifylline
Chelation Therapy
5.10. Homocysteine Lowering
5.11. Influenza Vaccination
STRUCTURED EXERCISE THERAPY
MINIMIZING TISSUE LOSS IN PATIENTS WITH PAD
REVASCULARIZATION FOR CLAUDICATION
Revascularization for Claudication
Endovascular Revascularization for Claudication
Surgical Revascularization for Claudication
MANAGEMENT OF CLI
Revascularization for CLI
Endovascular Revascularization for CLI
Surgical Revascularization for CLI
Wound Healing Therapies for CLI
10. MANAGEMENT OF ALI
10.1. Clinical Presentation of ALI
10.2. Medical Therapy for ALI
10.3. Revascularization for ALI
10.4. Diagnostic Evaluation of the Cause of ALI
11. LONGITUDINAL FOLLOW-UP
12. EVIDENCE GAPS AND FUTURE RESEARCH
13. ADVOCACY PRIORITIES
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