The AHA Guidelines and Scientific Statements Handbook

Lower Extremity Peripheral

Artery Disease

Alan T. Hirsch and Ziv J. Haskal

9

Scope, organization of committee and evidence
Data standards and performance measures
Vascular history and physical examination
Epidemiology, prognosis, and natural history of PAD
Clinical presentations
Asymptomatic PAD
Claudication
Critical limb ischemia
Acute limb ischemia
Prior limb arterial revascularization
Diagnostic methods
Ankle-brachial and toe-brachial indices, and segmental
pressure examination
Treadmill exercise testing with and without ABI
assessments and 6-minute walk test
Duplex ultrasound
Computed tomographic angiography
Magnetic resonance angiography
Contrast angiography
Treatment
Cardiovascular risk reduction
Lipid-lowering drugs
Antihypertensive drugs
Diabetes therapies
Smoking cessation
Antiplatelet and antithrombotic drugs
Claudication
Exercise and lower extremity pad rehabilitation
Pharmacological therapy of claudication
Endovascular treatment for claudication
Surgery for claudication
Critical limb ischemia and treatment for limb salvage
Medical and pharmacological treatment for CLI
Thrombolysis for acute and chronic limb ischemia
Surgery for CLI

Other guidelines: The Trans-Atlantic Inter-Society

Consensus Documents, TASC-I and TASC-II

Ongoing trials and future directions on PAD care

Scope, organization of committee

and evidence

The “Guidelines for the Management of Patients

with Peripheral Arterial Disease” address the diag-

nosis and management of atherosclerotic, aneurys-

mal, and thromboembolic peripheral arterial disease

(PAD). The guideline uses the term “peripheral arte-

rial disease” to encompass a large series of disorders

that affect arteries exclusive of the coronary arteries.

The writing committee chose to include within its

scope the disorders of the abdominal aorta, renal

and mesenteric arteries, and lower extremity arter-

ies. This chapter is more limited and will review the

recommendations encompassed in care for patients

with lower extremity PAD. Clinicians who seek the

highest possible practice standards and the evidence

base underpinning these recommendations are

strongly encouraged to refer to the full text docu-

ment to gain access to the 65 tables, more than 1300

references, and supporting text. The full-text docu-

ment can be accessed at http://www.acc.org/

clinical/guidelines/pad/index.pdf [1].

These guidelines were written by representatives

of the American College of Cardiology (ACC), the

American Heart Association; the Society for Cardio-

vascular Angiography and Interventions (SCAI);

Society for Vascular Medicine (SVM); Society for

Vascular Surgery (SVS); and Society of Interven-

tional Radiology (SIR). The document was peer

reviewed by additional representatives of these orga-

nizations prior to approval, and also reviewed and

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978 -1-405-18463-2