American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Management of Patients With Lower Extremity Peripheral Artery Disease

2024United States

Ce document comprend 10 recommandations, 20 tableaux et 8 figures.

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Synthèse

Lower extremity PAD is a common cardiovascular disease associated with an increased risk of amputation, myocardial infarction, stroke, and death. This comprehensive guideline updates the 2016 AHA/ACC PAD Guideline, providing evidence-based practices for clinical assessment, physiological testing, and interdisciplinary management—including GDMT, structured exercise, wound care, and revascularization strategies.

Messages clés

Peripheral artery disease (PAD) is a common cardiovascular disease associated with increased risk of amputation, myocardial infarction, stroke, and death, as well as impaired quality of life.
This guideline defines 4 clinical subsets of PAD: asymptomatic PAD, chronic symptomatic PAD (including claudication), chronic limb-threatening ischemia (CLTI), and acute limb ischemia (ALI).
Detection of PAD is primarily accomplished through history, physical examination, and resting ankle-brachial index (ABI).
Health disparities in PAD are associated with poor limb and cardiovascular outcomes and must be addressed.
Effective medical therapies include antiplatelet/antithrombotic therapy, lipid-lowering (high-intensity statin), antihypertensive therapy, diabetes management, and smoking cessation.
Low-dose rivaroxaban combined with low-dose aspirin is effective to prevent MACE and MALE in PAD patients not at increased risk of bleeding.
Structured exercise is a core component of care for patients with PAD.
Revascularization should be used to prevent limb loss in CLTI and can improve QOL in claudication unresponsive to medical therapy.

Recommandations

2.2. History and Physical Examination to Assess for PAD

In patients at increased risk of PAD, a comprehensive medical history and review of symptoms to assess for exertional leg symptoms, lower extremity rest pain, and lower extremity wounds or other ischemic skin changes should be performed.
Patients concernés: Patients at increased risk of PADSituation: Peripheral Artery Disease (PAD)
1Niveau de preuve : b-nrClinical Assessment

3.1. Resting ABI and Additional Physiological Testing

In patients with history or physical examination findings suggestive of PAD, the resting ABI, with or without ankle pulse volume recordings (PVR) and/or Doppler waveforms, is recommended to establish the diagnosis.
Patients concernés: Patients with history or physical examination findings suggestive of PADSituation: Peripheral Artery Disease (PAD)
1Niveau de preuve : b-nrDiagnostic Testing

5.1. Antiplatelet and Antithrombotic Therapy for PAD

In patients with symptomatic PAD, single antiplatelet therapy is recommended to reduce the risk of MACE.
Patients concernés: Patients with symptomatic PADSituation: Peripheral Artery Disease (PAD)
1Niveau de preuve : aMedical Therapy

5.2. Lipid-Lowering Therapy for PAD

In patients with PAD, treatment with high-intensity statin therapy is indicated, with an aim of achieving a ≥50% reduction in low-density lipoprotein cholesterol (LDL-C) level.
Patients concernés: Patients with PADSituation: Peripheral Artery Disease (PAD)
1Niveau de preuve : aMedical Therapy

5.3. Antihypertensive Therapy for PAD

In patients with PAD and hypertension, a systolic blood pressure (SBP) goal of <130 mm Hg and a diastolic blood pressure target of <80 mm Hg is recommended.
Patients concernés: Patients with PAD and hypertensionSituation: Peripheral Artery Disease (PAD) and Hypertension
1Niveau de preuve : b-rMedical Therapy

5.4. Smoking Cessation for PAD

Patients with PAD who smoke cigarettes or use any other forms of tobacco should be advised at every visit to quit or encouraged to maintain cessation.
Patients concernés: Patients with PAD who smoke cigarettes or use other forms of tobaccoSituation: Peripheral Artery Disease (PAD)
1Niveau de preuve : aLifestyle/Preventive Care

6. Exercise Therapy for PAD

In patients with chronic symptomatic PAD, SET is recommended to improve walking performance, functional status, and QOL.
Patients concernés: Patients with chronic symptomatic PADSituation: Chronic symptomatic PAD
1Niveau de preuve : aExercise Therapy

9.1. Revascularization for Claudication

In patients with functionally limiting claudication and hemodynamically significant aortoiliac or femoropopliteal disease with inadequate response to GDMT (including structured exercise), endovascular revascularization is effective to improve walking performance and QOL.
Patients concernés: Patients with functionally limiting claudication and hemodynamically significant aortoiliac or femoropopliteal diseaseSituation: Chronic symptomatic PAD (Claudication)
1Niveau de preuve : aInterventional/Surgical

Management of Patients With Lower Extremity Peripheral Artery Disease

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Recommandations

2.2. History and Physical Examination to Assess for PAD

3.1. Resting ABI and Additional Physiological Testing

5.1. Antiplatelet and Antithrombotic Therapy for PAD

5.2. Lipid-Lowering Therapy for PAD

5.3. Antihypertensive Therapy for PAD

5.4. Smoking Cessation for PAD

6. Exercise Therapy for PAD

9.1. Revascularization for Claudication

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Mots-clés

Synthèse

Messages clés

Posez une question sur cette recommandation.

Nouveautés de cette version

Recommandations

2.2. History and Physical Examination to Assess for PAD

3.1. Resting ABI and Additional Physiological Testing

5.1. Antiplatelet and Antithrombotic Therapy for PAD

5.2. Lipid-Lowering Therapy for PAD

5.3. Antihypertensive Therapy for PAD

5.4. Smoking Cessation for PAD

6. Exercise Therapy for PAD

9.1. Revascularization for Claudication

Champ d’application et patients concernés

Évaluation du niveau de preuve

Sécurité

Définitions

Pour apprendre

Recommandations associées

Supports pédagogiques

En bref

Mots-clés