Sandbox: Peripheral Arterial Disease: Difference between revisions
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==2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)== | ==2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)== | ||
===Recommendations in | ===Recommendations in Patients with Peripheral Arterial Diseases: Best Medical Therapy=== | ||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki> | ||
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| colspan="1" style="text-align:center; background:LemonChiffon"| [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''8.''' In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg.. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | | bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''8.''' In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg.. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | ||
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Revision as of 15:54, 30 October 2017
Template:Peripheral Arterial Disease
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]
==2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases (PAD), in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)==
Changes in Recommendations
What is new in the 2017 PAD Guidelines
| 2011 | 2017 |
|---|---|
| 2017 Change in Recommendations: | |
| Carotid Artery Disease | |
| IIb - Embolic Protection Devices (EPDs)in Carotid Stenting | IIa - Embolic Protection Devices (EPDs)in Carotid Stenting |
| Asymptomatic 60-90% carotid stenosis | |
| IIa - Surgery for all | IIa - Surgery for high stroke risk |
| IIb - Stenting as an alternative | IIa - Stenting in high surgery risk |
| IIa - Stenting in average surgery risk | |
| 2017 New Recommendations: | |
| IIb - Coronary angiography before elective carotid surgery | |
| III - Routine prophylactic revascularization of asymptomatic carotid 70-99% stenosis in patients undergoing CABG. | |
| 2017 Change in Recommendations: | |
| Upper Extremity Artery Disease | |
| I - Revascularisation for symptomatic subclavian artery stenosis | IIa - Revascularisation for symptomatic subclavian artery stenosis |
| Subclavian stenosis revascularization | |
| I - Endovascular first | IIa - Stenting or surgery |
| IIb - Revascularization for asymptomatic subclavian stenosis in patients with/planned for CABG | IIa - Revascularization for asymptomatic subclavian stenosis in patients with/planned for CABG |
| Renal Artery Disease | |
| IIb - Stenting for symptomatic atherosclerotic stenosis >60% | III - Stenting for symptomatic atherosclerotic stenosis >60% |
| 2017 New Recommendations: | |
| Renal Artery Disease | |
| Fibromuscular dysplasia balloon angioplasty with bailout stenting | |
| 2017 Change in Recommendations: | |
| Lower Extremity Artery Disease (LEAD) | |
| Aorto-iliac lesions | |
| IIa - Primary endovascular therapy for 'TASC-D' | IIa - Surgery in aorta-iliac or -bi-femoral occlusions |
| IIb - Endovascular as an alternative in experienced centres. | |
| Infra-popliteal lesions | |
| IIa - Endovascular first | I - Bypass using GSV |
| IIa - Endovascular therapy | |
| 2017 New Recommendations: | |
| Lower Extremity Artery Disease (LEAD) | |
| I - Statins to improve walking distance | |
| I - LEAD + Atrial Fibrillation (AF): Anticoagulation if CHAD-VASc >2 | |
| IIa - Angiography in Chronic limb-threatening ischaemia (CLTI) with below-the-knee lesions | |
| IIa - Duplex screening for Abdominal Aortic Aneurysm (AAA) | |
| IIa - In case of CABG: screen LEAD with ABI, limit vein harvesting if LEAD | |
| IIb - Screening for LEAD in patients with coronary artery disease (CAD) | |
| IIb - Screening for LEAD in patients with heart failure (HF) | |
| IIb - Clopidogrel preferred over aspirin | |
| III - Antiplatelet therapy in isolated asymptomatic LEAD | |
| 2017 New Recommendations: | |
| Mesenteric Artery Disease | |
| IIa - D-dimers to rule out acute mesenteric ischaemia | |
| III - No delay for re-nuutrition in case of symptomatic Chronic Mesenteric Ischaemia | |
| 2017 New Recommendations: | |
| All Peripheral Arterial Diseases (PADs) | |
| IIa - Screening for heart failure (BNP, TTE) | |
| IIa - Stable PADs + other conditions requiring anticoagulants (e.g. AF): anticoagulation alone | |
2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)
Recommendations in Patients with Peripheral Arterial Diseases: Best Medical Therapy
| Class I |
| "1. Smoking cessation is recommended in all patients with PADs. (Level of Evidence: B) " |
| "2. Healthy diet and physical activity are recom- mended for all patients with PADs. (Level of Evidence: C) " |
| "3. Statins are recommended in all patients with PADs. (Level of Evidence: A) " |
| "4. In patients with PADs, it is recommended to reduce LDL-C to < 1.8 mmol/L (70 mg/dL) or decrease it by ≥50% if baseline values are 1.8–3.5 mmol/L (70–135 mg/dL). (Level of Evidence: C) " |
| "5. In diabetic patients with PADs, strict glycae- mic control is recommended. (Level of Evidence: C) " |
| "6. Antiplatelet therapy is recommended in patients with symptomatic PADs. (Level of Evidence: C) " |
| "7. In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg. (Level of Evidence: A) " |
| Class IIa |
| "8. In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg.. (Level of Evidence: B) " |