ESC Publishes 2024 Guidelines Combining Peripheral Artery and Aortic Diseases

September 10, 2024—The European Society of Cardiology (ESC) recently announced the publication of the 2024 ESC Guidelines for the management of peripheral artery and aortic diseases (PAAD). The guidelines evaluate these vascular diseases together as part of the same cardiovascular system, acknowledging that patients with aortic diseases are at risk of having peripheral vascular diseases, and vice versa.

According to ESC, the guidelines are aimed at cardiologists but were coordinated for alignment with guidelines for surgeons by the European Association for Cardio-Thoracic Surgery (EACTS); they are endorsed by EACTS, VASCERN (European Reference Network on Rare Multisystemic Vascular Diseases), and ESVM (European Society of Vascular Medicine).

The ESC guidelines Cochairs are Lucia Mazzolai, MD, of Lausanne University Hospital in Lausanne, Switzerland, and Jose Fernando Rodriguez Palomares, MD, of University Hospital Vall d’Hebron in Barcelona, Spain. The guidelines were published by Professor Mazzolai et al in European Heart Journal.

“These updated guidelines have been introduced now due to significant advancements and shifts in our understanding and management of aortic and peripheral artery diseases, including new treatment modalities, since the last guidelines were published in 2014 and 2017, respectively,” commented Professor Rodriguez Palomares in the ESC press release.

Prof. Mazzolai added, “The decision to integrate these guidelines is based on several key factors. The aorta and peripheral arteries are integral components of the same arterial system. Disorders in one part of this system often have implications for the other. Combining the guidelines provides consistent and standardized recommendations for the management of arterial diseases as a whole. This ensures that patients receive cohesive and coordinated care across different vascular conditions, reducing fragmentation and improving overall treatment outcomes.”

As noted in the ESC press release, the guideline authors further stated that the most important recommendations in the new 2024 guidelines are those addressing the chronic nature of PAAD, the importance of screening, the necessity of comprehensive treatment strategies, and awareness that this a chronic disease that needs lifetime follow-up.

Also, the guidelines highlight that optimal pharmacological treatment (antithrombotic, lipid-lowering, antihypertensive, antidiabetic) and an emphasis on exercise and lifestyle changes are mandatory and effective in reducing the burden of disease. Patients with PAAD have a very high cardiovascular risk and require optimal management of risk factors such as hypertension, hyperlipidemia, and diabetes to prevent serious complications.

Finally, the authors concluded, “PAAD is a chronic disease necessitating lifelong follow-up by vascular specialists, cardiologists, and a multidisciplinary team. Women often present with atypical or asymptomatic disease, warranting special attention during screening. Exercise and lifestyle changes are crucial before considering interventional management in chronic PAAD.”