New multisociety clinical practice guidelines for the management of lower extremity peripheral arterial disease (PAD) have been published online in the Journal of the American College of Cardiology (JACC). One of the document’s key takeaway messages is that care for patients with PAD—and those with chronic limb-threatening ischemia (CLTI) in particular—is “optimized” when delivered by a multispecialty care team.
The JACC paper is the work of the American College of Cardiology (ACC), the American Heart Association (AHA) and nine other societies including the Society for Vascular Surgery (SVS) and the Society of Interventional Radiology (SIR).
Authored by cardiologist and writing committee chair Heather L Gornik (University Hospitals Harrington Heart & Vascular Institute, Cleveland, USA) and colleagues, the 2024 guidance aimed to advise clinicians on the treatment of patients with lower extremity PAD across its multiple clinical presentation subsets—asymptomatic, chronic symptomatic, CLTI, and acute limb ischemia (ALI). The document represents an update to the 2016 AHA/ACC guidelines on PAD.
Among a list of key take-home messages from the guidance, Gornik et al highlight that health disparities in PAD “must be addressed at the individual and population levels,” recommending that interventions be “coordinated between multiple stakeholders across the cardiovascular community and public health infrastructure.”
Recommendations regarding medical therapy are also underlined, with the writing committee advising that rivaroxaban (2.5mg twice daily) combined with low-dose aspirin (91mg) “is effective to prevent major adverse cardiovascular events and major adverse limb events in patients with PAD who are not at increased risk of bleeding.”
Furthermore, structured exercise is labelled a “core component” of care for patients with PAD, and the writing committee states that revascularization—whether endovascular, surgical, or hybrid—“should be used to prevent limb loss in those with chronic limb-threatening ischaemia and can be used to improve QoL [quality of life] and functional status in patients with claudication not responsive to medical therapy and structured exercise.”
The guidelines continue that foot care is “crucial” for patients with PAD across all clinical subsets and that podiatrists and other specialists with expertise in foot care, wound-healing therapies, and foot surgery “are important members of the multispecialty care team.”
Finally, the guidelines mention the PAD National Action Plan, which, the authors write, outlines six strategic goals to improve awareness, detection, and treatment of PAD nationwide. “Implementation of this action plan is recognized as a top advocacy priority by the writing committee,” the JACC paper reads.
