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.