Review article

Peripheral artery disease of lower extremities – review of the European Society of Cardiology guidelines.

Majda Vrkić Kirhmajer orcid.org/0000-0002-1340-1917 ; University Hospital Centre Zagreb, Zagreb, Croatia
Ljiljana Banfić ; University Hospital Centre Zagreb, Zagreb, Croatia

Abstract

Peripheral artery disease (PAD) of the lower extremities has been recognized as a serious cardiovascular disorder. Symptomatic and asymptomatic PAD is a predictor of myocardial infarction, stroke and cardiovascular mortality. In 2011 the first European Society of Cardiology guidelines on PAD diagnostics and treatment were published. The guidelines include atherosclerotic disease of all non-coronary vascular areas, and a great part of the guidelines covers occlusive artery disease of lower extremities.
The main diagnostic test is the ankle-brachial index measurement (ABI), which in addition to confirmation of the diagnosis indicates the severity of the disease. ABI values <0.9 are pathological, while ABI <0.5 carries a high risk of amputation. The combination of ABI and duplex ultrasound is sufficient for making an optimal treatment decision for most of the patients. Digital subtraction angiography is today used mainly when the endovascular intervention is planned.
General recommendations for treatment of PAD include giving up smoking, encouraging daily physical activity, overweight reduction and opting for Mediterranean diet. Antihypertensive drugs, statins and antiplatelet drugs are the basic drugs in pharmacotherapy. Patients with intermittent claudications must be familiar with the importance of regular walking exercises that significantly prolong the walking distance. Revascularization in asymptomatic patients is not recommended. In many centers today, percutaneous transluminal angioplasty (PTA) is preferred as the first revascularization method, while the surgical revascularization is preferred in case of failure of PTA. The attempt of revascularization is mandatory in the event of for critical ischemia. Revascularization is justified in case of aortoiliac disease and in all patients that despite a three-month conservative therapy still have claudications which severely impair their quality of life.
Treatment of patients with PAD often requires a multidisciplinary approach. Application of guidelines in daily practice provides additional safety in making the decision on optimal method of treatment for each patient.

Keywords

peripheral artery disease; guidelines

Hrčak ID:

94683

URI

https://hrcak.srce.hr/94683

Publication date:

24.9.2012.

Article data in other languages: croatian

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