CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

October 3rd, 2011

Guidelines for Managing Peripheral Artery Disease Updated

The ACC and the AHA have released updated guidelines for managing peripheral artery disease (PAD). The document is available online in the Journal of the American College of Cardiology and in Circulation.

The new guidelines place a greater emphasis on tobacco cessation, requesting healthcare providers to consistently ask patients about their smoking status and to offer support to help them quit through counseling and formal smoking cessation programs. Pharmacotherapy for smoking cessation gains a class I recommendation, with the guidelines stating that at least one of following should be offered: varenicline, bupropion, or nicotine replacement therapy.

The updated guidelines recommend measurement of the ankle-brachial index (ABI) in patients 65 years of age or older. In the 2005 guidelines, the recommendation was for ABI to be used in patients 70 years or older.

Antiplatelet therapy can be used in asymptomatic patients with an ABI of 0.90 or lower, but is not recommended for those with a borderline ABI. Oral anticoagulants are not recommended as an addition to antiplatelet therapy.

Bypass surgery is described as a reasonable initial treatment in patients with limb-threatening ischemia and a life expectancy greater than 2 years.

Open and endovascular repair are said to be nearly equivalent in terms of safety and efficacy for the treatment of aortic aneurysms.

Categories: Anticoagulation, Prevention, Vascular
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2 Responses to “Guidelines for Managing Peripheral Artery Disease Updated”

  1. Frederick Fuentes, M.D. says:
    October 4, 2011 at 7:12 am

    No update on how the ABI itself should be determined: low-pressure or high-pressure method? The recent ESC guideline wasn’t so clear-cut on this regard… citing some evidence that low-pressure may be the way to go since it has higher sensitivity.

  2. Jean-Pierre Usdin, MD says:
    October 9, 2011 at 4:37 pm

    dear colleagues
    I wonder if the measurement of ABI in clinical practice is realistic.
    The devices in the market (in France) at the present time do not permit a record of ABI in less than 10minutes!
    I personnaly use this index, with a systematic approach, in high risk patients.
    The other possibility is to perform a Doppler study; but a recent Feature in “Journal Watch” October 1st 2011 vol. 39 n° 19, seems to be concerned about some numbers of artery ultrasonography which conduct to the dilemma of the treatment of the asymptomatic narrowing(of carotid stenosis…)
    what do you think?

    Competing interests pertaining specifically to this post, comment, or both:
    no conflict of interest for this topic