ESC Focus on Interventions & PC - 4

Main Session

2017 ESC Clinical Practice Guidelines on Diagnosis and Treatment
of Peripheral Arterial Diseases
Written by Phil Vinall

Reviewing and updating guidelines is an important
part of the European Society of Cardiology's (ESC)
mission. New and/or updated recommendations are
typically presented at the Society's annual meeting.
The following is an overview of the 2017 ESC Clinical
Practice Guidelines on the Diagnosis and Treatment
of Peripheral Artery Diseases (PADs), developed in
collaboration with the European Society for Vascular
Surgery (ESVS), and presented on 28 August.
Diagnosis and Treatment of PADs
Victor Aboyans, MD, PhD, Dupuytren University, Limoges,
France, noted that the guidelines cover arterial disease
at every location except for the aortic, coronary, and
intracranial arteries. There is also a special section on
multisite artery disease and a new chapter on cardiac
conditions frequently found in patients with PADs.
General Prevention and Antithrombotic Therapies
Proper management for patients with PADs requires
attention to both general cardiovascular (CV) risk prevention and specific locally related symptoms. Lucia
Mazzolai, MD, PhD. Lausanne University Hospital,
Lausanne, Switzerland, discussed general prevention.

Key steps include a thorough clinical history, physical
examination, and laboratory testing. The Ankle-Brachial
Index (ABI) is not only important for diagnosis of lower
extremity artery disease (LEAD), but it also can be used
for CV risk stratification and serves as a general marker
of CV disease risk. Best medical therapy for patients
with PADs should include both pharmacologic and nonpharmacologic measures (Table 1).
Antithrombotic Therapy
Jean-Phillippe Collet, MD, Paris-Sorbonne Université,
Paris, France, noted that long-term single antiplatelet
therapy (SAPT) is recommended for patients with symptomatic carotid artery stenosis (Class I Level A) and DAPT
is recommended for ≥ 1 month after carotid stenting (I A).
For asymptomatic patients with a > 50% stenosis, longterm SAPT (usually low-dose aspirin) should be considered
when there is a low risk of bleeding (IIa C; Figure 1).
In patients with LEAD who do not require anticoagulation, the use of antiplatelet therapy is not routinely indicated in patients with isolated asymptomatic disease (III A).
Figure 1. Antiplatelet Therapy in Patients With Carotid Artery Stenosis
Management of Antiplatelet Therapy in Carotid Artery Stenosis
Asymptomatic

Table 1. Guidelines for General Prevention of Cardiovascular Disease in
Patients With PAD
Class

Level

Healthy diet and physical activity (all patients with
PADs)

I

C

Smoking cessation (all patients with PADs)

I

Control BP at < 140/90 mm Hg (patients with PADs
+ hypertension)
Consider ACEIs or ARBs as first line therapy
(patients with PADs + hypertension)

4

0

Time Delay

Recommendations

A

IIa

B

Statins (all patients with PADs)

I

A

Reduce LDL-C to < 1.8 mmol/L (70 mg/dL) or decrease
it by ≥ 50% if baseline values are 1.8-3.5 mmol/L
(70 - 135 mg/dL) (all patients with PADs)

I

C

Carotid Surgery

DAPT
A+C
Class I A

1 mo.

SAPTa
A or C
Class IIa C

B

I

Carotid Artery Stenting

SAPTc
A or C

SAPTb

Class I A

A or C
Class I A

1 year
Long Termd

A

Aspirin 75-100 mg/day

C

Clopidogrel 75 mg/day

a At the exception of patient at very high bleeding risk.
b DAPT may be used if another indication supersedes that of carotid artery stenting such as acute
coronary syndrome or percutaneous coronary intervention of less than 1 year.
c In case of recent minor stroke or TIA. A loading dose of aspirin (300 mg) and/or clopidogrel
(300/600 mg) is recommended at the acute phase of stroke/TIA or during CAS.
d Stands for as long as it is well tolerated.

ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor
blockers; BP, blood pressure.

ACS, acute coronary syndrome; ASA, aspirin; CAS, carotid artery stenting; DAPT,
dual antiplatelet therapy; PCI, percutaneous coronary intervention; SAPT, single
antiplatelet therapy; TIA, transient ischaemic attack.

Reprinted from Aboyans V, Ricco JB et al. 2017 ESC Guidelines on the Diagnosis
and Treatment of Peripheral Arterial Diseases. Eur Heart J. 2017; doi:10.1093/
eurheartj/ehx095. By permission of Oxford University Press on behalf of the
European Society of Cardiology.

Reprinted from Aboyans V, Ricco JB et al. 2017 ESC Guidelines on the Diagnosis
and Treatment of Peripheral Arterial Diseases. Eur Heart J. 2017; doi:10.1093/
eurheartj/ehx095. By permission of Oxford University Press on behalf of the
European Society of Cardiology.

October 2017

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Table of Contents for the Digital Edition of ESC Focus on Interventions & PC

Contents
ESC Focus on Interventions & PC - Cover1
ESC Focus on Interventions & PC - Cover2
ESC Focus on Interventions & PC - 1
ESC Focus on Interventions & PC - 2
ESC Focus on Interventions & PC - Contents
ESC Focus on Interventions & PC - 4
ESC Focus on Interventions & PC - 5
ESC Focus on Interventions & PC - 6
ESC Focus on Interventions & PC - 7
ESC Focus on Interventions & PC - 8
ESC Focus on Interventions & PC - 9
ESC Focus on Interventions & PC - 10
ESC Focus on Interventions & PC - 11
ESC Focus on Interventions & PC - 11A
ESC Focus on Interventions & PC - 11B
ESC Focus on Interventions & PC - 11C
ESC Focus on Interventions & PC - 11D
ESC Focus on Interventions & PC - 12
ESC Focus on Interventions & PC - 13
ESC Focus on Interventions & PC - 14
ESC Focus on Interventions & PC - 15
ESC Focus on Interventions & PC - 16
ESC Focus on Interventions & PC - 17
ESC Focus on Interventions & PC - 18
ESC Focus on Interventions & PC - 19
ESC Focus on Interventions & PC - 20
ESC Focus on Interventions & PC - Cover3
ESC Focus on Interventions & PC - Cover4
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