From the Guidelines
The new Peripheral Artery Disease (PAD) guideline recommendations prioritize a comprehensive approach to managing PAD, including structured exercise, revascularization, and medical therapy to improve quality of life and reduce morbidity and mortality. The guidelines recommend structured exercise as a core component of care for patients with PAD, including supervised exercise therapy and community-based programs 1. Revascularization, such as endovascular or surgical procedures, should be used to prevent limb loss in patients with chronic limb-threatening ischemia and to improve quality of life and functional status in patients with claudication not responsive to medical therapy and structured exercise 1. Care for patients with PAD is optimized when delivered by a multispecialty care team, including podiatrists and other specialists with expertise in foot care, wound-healing therapies, and foot surgery 1. The guidelines also emphasize the importance of foot care, health disparities, and lifestyle modifications, such as smoking cessation and a healthy diet, in managing PAD 1. Key recommendations include:
- Using validated assessment tools to detect PAD and evaluate its severity
- Prescribing effective medical therapies to prevent major adverse cardiovascular events and major adverse limb events
- Implementing lifestyle modifications, such as smoking cessation and a healthy diet, to reduce the risk of PAD and its complications
- Considering revascularization and other interventions to improve quality of life and reduce morbidity and mortality in patients with PAD. Overall, the new PAD guideline recommendations aim to improve the management of PAD and reduce its associated morbidity and mortality by promoting a comprehensive and multidisciplinary approach to care.
From the Research
New Peripheral Artery Disease (PAD) Guideline Recommendations
The new guidelines for managing Peripheral Artery Disease (PAD) emphasize a comprehensive and multidisciplinary approach, focusing on prevention, diagnosis, treatment, and follow-up of patients with PAD 2. The main goals of PAD management are to improve functioning, prevent adverse events, and reduce the overall atherosclerotic burden 2.
Key Recommendations
- Current guidelines recommend smoking cessation, aspirin, statin, and renin-angiotensin system inhibitors to reduce the risk of cardiovascular and limb-related adverse events 3.
- Supervised exercise training is recommended for patients with exertional limb symptoms 4, 2.
- Interventional treatment is indicated for limb salvage in patients with chronic limb threatening ischemia and may also be discussed in a multidisciplinary setting in less severe patients with persisting symptoms and reduced quality of life after a minimum period of optimal medical treatment including exercise therapy 2.
- Patients should have adequate blood pressure and lipid control to decrease clinical manifestations and symptoms of PAD 5.
- Use of antithrombotic medications should be individualized to the patient depending on the presence of symptoms, revascularization, and comorbidities 5.
Medical Management
- Antithrombotic therapy, lipid lowering, blood pressure control, diabetes management, smoking cessation, and exercise programs have been shown to improve symptoms and reduce complications in PAD patients 6.
- Core elements of PAD secondary prevention clinics include optimal medical therapies and relevant tools to overcome barriers to evidence-based medical therapies 6.
- A comprehensive approach is required to improve outcomes in patients with PAD, including tobacco cessation, pharmacologic management of metabolic fitness, risk-factor modification, and exercise training 4.