SCAI Publishes Expert Consensus Recommendations for Treating Below-the-Knee PAD

July 18, 2014—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the publication of expert consensus recommendations, “SCAI Expert Consensus Statement for Infrapopliteal Arterial Intervention Appropriate Use,” which are available online ahead of print in SCAI’s Catheterization and Cardiovascular Interventions. Bruce H. Gray, DO, FSCAI, Professor of Surgery/Vascular Medicine, University of South Carolina School of Medicine, is lead author of the consensus paper.

The expert panel reviewed scientific data on each critical limb ischemia (CLI) treatment option, including balloon angioplasty, stents, and atherectomy, as well as experimental therapies such as drug-coated balloons. SCAI noted that the incidence of obesity and diabetes is increasing, and so is the number of patients with peripheral artery disease (PAD). Elderly patients and those with long-standing diabetes or chronic kidney disease are at greatest risk of developing blockages that can progress to CLI. As the population ages and the number of patients with diabetes rises, the rate of CLI is expected to increase.

The recommendations state that patients with severe disease, those with pain at rest, and those with minor or major tissue loss should be considered for revascularization, with either surgery or endovascular treatment to prevent amputation or improve healing after amputation. Currently there is insufficient evidence to support treatment in those with asymptomatic disease.

Dr. Gray commented in SCAI’s announcement, “Treating patients with infrapopliteal arterial disease and CLI can relieve pain, heal ulcerations, preserve limbs, and improve quality of life and function. Depending on the patient’s condition, open surgery, an endovascular intervention, or amputation are considered appropriate courses of action. These new recommendations aim to help guide physicians to make the best care decisions when an endovascular approach is appropriate.”  

SCAI President Charles Chambers, MD, added, “SCAI is committed to providing physicians with the necessary tools to appropriately diagnose and treat patients. These recommendations were developed based on our belief that patient safety and quality should always be physicians’ top priority.”   

Previous documents included “SCAI Expert Consensus Document for Aorto-Iliac Arterial Intervention Appropriate Use," released on May 28, 2014, and “SCAI Expert Consensus Document for Femoral-Popliteal Arterial Intervention Appropriate Use,” released on June 12, 2014. The final document in the series will focus on renal artery stenosis and will be published in Catheterization and Cardiovascular Interventions later this summer.