The position of Polish experts on conservative management in patients with artery diseases of lower limbs

Abstract

Peripheral artery disease (PAD) is a common disease, though not very well known and often diagnosed on a very late stage, causing not only typical complications such as intermittent claudication, critical limb ischemia or amputations, but also to cardiovascular mortality. The risk of cardiovascular death can be even 11 times higher in patients with symptomatic PAD than in healthy patients. The risk of heart attack, stroke or cardiovascular death is even higher, reaching almost 4% within one year, nearly equal to the risk for patients with coronary artery disease (CAD). In those patients, the 5-year mortality risk is estimated at 10–15%, with cardiovascular disorders being the most likely cause of death. In patients with critical limb ischemia, the risk of cardiovascular death within one year can be as high as 25% and the risk of amputation — 30%. It is estimated that the global population of patients with PAD is over 120 million. The incidence of the diseases is 3–10%, but in patients aged 70 and more, the incidence increases to 14–29%. In Poland, around 4,000 people are hospitalized every year for PAD of lower limbs. The number of PAD-related amputations is over 9,000 per year. Although the methods of PAD diagnosis (e.g. ABI) are often easy and non-invasive, they are scarcely used in clinical practice. Also, optimal conservative management in the form of quitting smoking, modifying the cardiovascular risk factors and supervised exercise is often overlooked. PAD is a major issue not only for vascular surgery, but also for many other medical specializations, including angiology, general medicine, cardiology, or diabetology. As a result of long waiting times for the next visit and lack of access to patient programmes and reimbursed drugs, patients with PAD often report to the doctor when their condition is very serious. Despite the 2017 ESC guidelines on the diagnosis and treatment of peripheral artery disease, prepared together with ESVS, not all healthcare professionals have access to the latest knowledge on PAD diagnosis and treatment. Unfortunately, though published recently, the ESC’s guidelines do not include some of the recent studies, among them the possibly breakthrough COMPASS trial which has the potential to change the paradigm of management of patients with PAD. We must bear in mind that the population with PAD is a difficult patient group who need new treatment methods and optimization of the existing ones in order to visibly improve diagnosis, treatment and prognosis.