By Thom Rooke, MD, FACC, Krehbiel Professor of Vascular Medicine at the Mayo Clinic and Alan T. Hirsch, MD, FACC, Professor of Medicine, Epidemiology and Community Health, at the University of Minnesota Medical School. Rooke is the chair of the PAD Guidelines Writing Committee. Hirsch is its vice chair.

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The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) today released updated guidelines for the diagnosis and management of peripheral artery disease (PAD), as part of PAD Awareness Month. The updated document provides agreed-upon approaches and treatments for PAD that clinicians can apply to help improve patient care.

PAD is a major American health problem. It affects one out of every 20 Americans over the age of 50, making it one of the most common cardiovascular diseases. In addition, its effects can be devastating: heart attack, stroke, leg amputations and death all can result from PAD. Despite this, scientific advances have made it possible to inexpensively and accurately diagnosis the disease, as well as effectively treat it.

However, reducing its prevalence will require more active detection. The focused update details the specific population who would benefit from an active approach to PAD diagnosis through ankle-brachial index (ABI) diagnostic testing. Specifically, the document recommends that ABI diagnostic testing is performed beginning at age 65, rather than age 70. This decision was based on mounting evidence demonstrating that people 65 and older have a one in five chance of having either symptomatic or asymptomatic PAD. 

Other recommendations set forth in the guidelines include:

• Strengthening efforts to help individuals with PAD quit smoking and, in turn, lower rates of heart attack, stroke and lower limb amputations. This includes consistently asking current and former smokers about tobacco use at each visit, as well as proactively offering support through counseling, pharmacologic therapies and/or formal smoking cessation programs
• Considering leg artery angioplasty as a first line treatment for certain individuals with severe PAD who may face amputation. Because angioplasty does not provide an ideal treatment for all patients with PAD, in particular for those in whom a lifespan greater than two years is anticipated, traditional vascular surgery may be more durable and most effective
• Understanding new data showing that aortic aneurysms can be safely treated by both traditional open surgical and less invasive endovascular treatments with nearly equal efficacy and safety

The guidelines provide a road map to greater prevention opportunities, which will be necessary if we are to reduce the number of people needlessly affected by PAD. Full text of the new guidelines -- which update the original 2005 recommendations and are collaboration with representatives from the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine and Society for Vascular Surgery -- are online, as is a summary on CardioSource.