AHA and ACC guidelines on peripheral vascular disease (PVD)
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What are the AHA and ACC guidelines on peripheral vascular disease (PVD)?
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@geeno AHA/ACC Guideline on Lower-Extremity Peripheral Artery Disease
In November 2016, the American Heart Association (AHA) and the American College of Cardiology (ACC) published the following recommendations on lower-extremity peripheral artery disease (PAD) :The vascular examination for PAD includes pulse palpation, auscultation for femoral bruits, and inspection of the legs and feet; lower-extremity pulses are assessed and rated as follows: 0, absent; 1, diminished; 2, normal; or 3, bounding
To confirm the diagnosis of PAD, abnormal physical examination findings must be confirmed with diagnostic testing, generally with the ankle-brachial index (ABI) as the initial test
Patients with confirmed diagnosis of PAD are at increased risk for subclavian artery stenosis; an inter-arm blood pressure difference of >15 to 20 mm Hg is abnormal and suggestive of subclavian (or innominate) artery stenosis; measuring blood pressure in both arms identifies the arm with the highest systolic pressure, a requirement for accurate measurement of the ABI
Resting ABI results should be reported as abnormal (ABI ≤0.90), borderline (ABI 0.91-0.99), normal (1.00-1.40), or noncompressible (ABI >1.40)
ABI is not recommended in patients who are not at increased risk of PAD and who do not have a history or physical examination findings suggestive of PAD
Toe-brachial index (TBI) should be measured to diagnose patients with suspected PAD when the ABI is >1.40
Patients with exertional non–joint-related leg symptoms and normal or borderline resting ABI (>0.90 and ≤1.40) should undergo exercise treadmill ABI testing to evaluate for PAD
Patients with PAD should receive a comprehensive program of guideline-directed medical therapy, including structured exercise and lifestyle modification, to reduce cardiovascular ischemic events and improve functional status
Antiplatelet therapy with aspirin alone (range, 75-325 mg/day) or clopidogrel alone (75 mg/day) is recommended to reduce myocardial infarction (MI), stroke, and vascular death in patients with symptomatic PAD
Treatment with a statin medication is indicated for all patients with PAD
Patients with PAD who smoke cigarettes or use other forms of tobacco should be advised at every visit to quit
Cilostazol is an effective therapy to improve symptoms and increase walking distance in patients with claudication
Endovascular procedures are effective as a revascularization option for patients with lifestyle-limiting claudication and hemodynamically significant aortoiliac occlusive disease
When surgical revascularization is performed, bypass to the popliteal artery with autogenous vein is recommended in preference to prosthetic graft material