2017 ESC Guidelines for PAD Diagnosis and Treatment

Authors:
Aboyans V, Ricco JB, Bartelink ML, et al.
Citation:
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. Eur Heart J 2017;Aug 26:[Epub ahead of print].

The following are key points to remember about the 2017 European Society of Cardiology (ESC) Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases:

  1. Healthcare centers are strongly recommended to establish multidisciplinary Vascular Teams to make decisions and manage patients with peripheral arterial diseases, including public awareness efforts.
  2. For patients with carotid artery disease, surgery or stenting (with embolic protection devices) is recommended (Class IIa) for high stroke risk patients, while stenting alone can be considered (Class IIb) for average surgical risk patients.
  3. Routine prophylactic carotid revascularization of asymptomatic carotid disease (70-99%) is not recommended (Class III) in patients undergoing coronary artery bypass graft (CABG) surgery.
  4. Stenting is no longer recommended (Class III) for patients with symptomatic atherosclerotic renal artery stenosis of >60%.
  5. Patients with aorto-iliac or aorto-bifemoral occlusions are recommended for surgical intervention (Class IIa) or endovascular revascularization in experienced centers (Class IIb).
  6. Patients with intrapopliteal lesions should be treated with bypass surgery (Class I) or endovascular therapy (Class IIa).
  7. All patients with lower extremity artery disease should be treated with statins to improve walking distance (Class I) as well as supervised exercise therapy, even after revascularization.
  8. In patients with symptomatic peripheral artery disease, clopidogrel can be considered over aspirin therapy (Class IIb). Antiplatelet therapy is not recommended in asymptomatic peripheral artery disease patients (Class III).
  9. Patients with lower extremity artery disease and concurrent atrial fibrillation should receive anticoagulation if the CHA2DS2-VASc score is >2 (Class I).
  10. Patients with coronary artery disease or heart failure should be considered for lower extremity peripheral artery disease screening (Class IIb).

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