Complete Adherence to Guideline-Directed Care in PAD Shows Decreased MALE at 2 Years

June 10, 2026—The Society for Vascular Surgery (SVS) announced that new study data show that patients with peripheral artery disease who adhere to preoperative guideline-directed care (GDC) are more likely to remain free from major adverse limb events (MALE) for up to 2 years after intervention. GDC includes documentation of severe lifestyle limitation, exercise therapy, and optimal medical therapy (OMT).

According to the SVS, the evidence demonstrated the impact of guideline-directed care for patients with claudication. The findings were presented at VAM26, the SVS Vascular Annual Meeting. 

As summarized in the society’s press release, the study evaluated whether adherence to GDC before surgical intervention is associated with improved long-term limb outcomes. Adherence was evaluated across three components: 1) documentation of severe lifestyle-limiting symptoms; 2) adherence to OMT, including single antiplatelet therapy, lipid-lowering therapy, and smoking cessation; and 3) completion of exercise therapy.

The primary outcome was freedom from MALE over 2 years following treatment. The study enrolled 258 patients, all of whom underwent surgery. The researchers compared postprocedural outcomes based on the degree of adherence to GDC.

SVS reported that 12.8% of the study population was nonadherent to GDC; 73.3% were partially adherent (OMT only); and 12.8% were completely adherent.

At 2 years, the investigators found that MALE occurred in 23.3% of patients, primarily caused by reinterventions. Per Kaplan-Meier analysis, patients with nonadherence to GDC had a MALE-free survival rate of 66.6%; partially adherent patients had a 76.7% rate; and patients with complete adherence had an 87.9% rate (P < .01).

SVS noted that the study investigators are from the Medical University of South Carolina (MUSC) in Charleston, South Carolina. The senior investigator for the study is Adam Tanious, MD, an Associate Professor in the Division of Vascular Surgery at MUSC.

To combat nonadherence, the investigators have developed an electronic health record-based clinical pathway to help claudicants receive guideline-directed care before surgery. They are currently running a prospective study at MUSC with > 100 patients enrolled. They aim to present this data at future society meetings, noted the SVS press release.

“Our study was designed to establish the evidence of a comprehensive multidisciplinary approach before considering surgical intervention,” commented Richard Shi, MD. Dr. Shi, who is a vascular surgery resident at MUSC, continued, “Too often, surgery is viewed in isolation rather than as one part of a broader continuum of care. By highlighting the role of preoperative GDC over immediate intervention or intervention in isolation, we hope to encourage more coordinated care pathways and improved patient outcomes.”

Dr. Tanious added, “This study highlights the important role vascular surgeons and interventionalists have in ensuring that patients meet the full continuum of preoperative GDC before offering surgery. These findings reinforce the importance of surgical appropriateness in claudicants and emphasize the need for established guidelines and pathways to direct care for this patient population.”