Abstract

Developed in Collaboration With the American Association of Cardiovascular and Pulmonary Rehabilitation, Inter-Society Consensus for the Management of Peripheral Arterial Disease, Society for Cardiovascular Angiography and Interventions, Society for Clinical Vascular Surgery, Society of Interventional Radiology, Society for Vascular Medicine, Society for Vascular Nursing, Society for Vascular Surgery, and Vascular and Endovascular Surgery Society

Highlights

  • This document was reviewed by 2 official reviewers nominated by the ACC and AHA; 1 to 2 reviewers each from the American Association of Cardiovascular and Pulmonary Rehabilitation, Inter-Society Consensus for the Management of Peripheral Arterial Disease, Society for Cardiovascular Angiography and Interventions, Society for Clinical Vascular Surgery, Society of Interventional Radiology, Society for Vascular Medicine, Society for Vascular Nursing, Society for Vascular Surgery, and Vascular and Endovascular Surgery Society; and 16 additional individual content reviewers

  • This document was approved for publication by the governing bodies of the ACC and the AHA and endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Inter-Society Consensus for the Management of Peripheral Arterial Disease, Society for Cardiovascular Angiography and Interventions, Society for Clinical Vascular Surgery, Society of Interventional Radiology, Society for Vascular Medicine, Society for Vascular Nursing, Society for Vascular Surgery, and Vascular and Endovascular Surgery Society

  • This document supersedes recommendations related to lower extremity PAD in the “ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease”[10] and the “2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease.”[11]. 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

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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 research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, e688 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 highquality systematic review that synthesized evidence from observational data and an RCT15; additional RCTs addressing this question are ongoing.[16,17,18] 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
CLINICAL ASSESSMENT FOR PAD
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
Smoking Cessation
Glycemic Control
Homocysteine Lowering
STRUCTURED EXERCISE THERAPY
MINIMIZING TISSUE LOSS IN PATIENTS
REVASCULARIZATION FOR CLAUDICATION
Revascularization for Claudication
MANAGEMENT OF CLI
Revascularization for CLI
Endovascular procedures are recommended to
Surgical Revascularization for CLI
Surgical procedures are recommended to
Wound Healing Therapies for CLI
10. MANAGEMENT OF ACUTE LIMB ISCHEMIA
10.1. Clinical Presentation of 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 DIRECTIONS
13. ADVOCACY PRIORITIES
Evaluation*
Full Text
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