ESC and ESVS Collaborate on Guidelines for the Diagnosis and Treatment of PAD
August 30, 2017—European Society of Cardiology (ESC) guidelines on the diagnosis and treatment of peripheral arterial diseases, developed in collaboration with the European Society for Vascular Surgery (ESVS), have been published online in European Heart Journal, European Journal of Vascular and Endovascular Surgery, and the ESC website. The guidelines are accompanied by a companion question-and-answer document that outlines how to manage patients with different presentations of peripheral artery disease (PAD).
According to the announcement by ESC, this is the first time that ESC recommendations on PAD have been developed as a collaborative effort between cardiologists and vascular surgeons. The task force was led by Professor Victor Aboyans, MD, (the ESC Chairperson) and Professor Jean-Baptiste Ricco, MD (ESVS Co-Chairperson).
Prof. Aboyans commented in the announcement, “We now have a single European document on the management of patients with peripheral arterial diseases. Working together has enabled us to be comprehensive in our recommendations.”
As outlined in the ESC press release, the PAD guidelines address new developments in the use of antithrombotic drugs, management of accompanying cardiac conditions, and treatment of asymptomatic carotid artery disease, renal artery disease, mesenteric artery disease, and lower extremity artery disease. Highlights include a single chapter devoted to the use of antithrombotic drugs regarding each location of PAD and a new chapter focusing on the management of other cardiac conditions frequently encountered in patients with PAD such as heart failure, atrial fibrillation, and valvular heart disease.
Since the publication of the 2011 guidelines, there have there have been no new major trials on the management of asymptomatic carotid artery disease, but there have been new data on the long-term risk of stroke in patients with asymptomatic carotid stenosis. Therefore, the task force now recommends revascularization of asymptomatic carotid stenosis only in patients at high risk of stroke.
Prof. Aboyans commented, “The previous guidelines recommended revascularization for all patients with asymptomatic carotid stenosis. Trials showing the benefits of revascularization compared to best medical therapy alone were performed in the 1990s, but stroke rates in all patients with asymptomatic carotid stenosis have decreased since then—regardless of the type of treatment—so the applicability of those trial results in the current management of these patients is more questionable.”
Additionally, there is now a strong recommendation against systematic revascularization of renal stenosis in patients with renal artery disease, following the publication of several trials. The 2011 guidelines stated that stenting could be considered in patients with renal stenosis caused by atherosclerotic disease.
Furthermore, the chapter on mesenteric artery disease has been entirely revisited and was updated with new data showing the interest of endovascular surgery in these often frail patients, according to Prof. Ricco. The guidelines also place an increased emphasis on the importance of the new Wound, Ischemia, and Foot Infection classification that was introduced for risk stratification of patients with chronic limb-threatening ischemia.