ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

doi:10.1097/01.RVI.0000240426.53079.46

Journal of Vascular and Interventional Radiology

Volume 17, Issue 9, September 2006, Pages 1383-1398

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https://doi.org/10.1097/01.RVI.0000240426.53079.46 Get rights and content

A Collaborative Report from the American Associations for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease)—Summary of Recommendations

Section snippets

PREAMBLE

THE following is recommendationonly summary of the recently published Guidelines for the Management of Patients with Peripheral Arterial Disease (PAD), developed by the ACC/AHA Task Force on Practice Guidelines. Readers are referred to the full-text version (1) as well as the executive summary (2) of the original document that, due to length considerations, could not be presented in their entirety in this journal. The authors of the original full document are included following the title.

A. Classification of Recommendations

Class I: Conditions for which there is evidence for and/or general agreement that a given procedure or treatment is beneficial, useful, and effective.

Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.

Class IIA: weight of evidence/opinion is in favor of usefulness/efficacy.

Class IIB: usefulness/efficacy is less well established by evidence/opinion.

Class III: Conditions for which there is evidence

A. Lower-extremity PAD: General Recommendations for Diagnosis and Therapy by Clinical Presentation

(1) Asymptomatic

Class I

1.
A history of walking impairment, claudication, ischemic rest pain, and/or nonhealing wounds is recommended as a required component of a standard ROS for adults 50 years and older who have atherosclerosis risk factors and for adults 70 years and older. (Level of evidence: C)
2.
Individuals with asymptomatic lower-extremity PAD should be identified by examination and/or measurement of the ABI so that therapeutic interventions known to diminish their increased risk of

A. Clinical Clues to the Diagnosis of Renal Artery Stenosis

Class I

1.
The performance of diagnostic studies to identify clinically significant renal artery stenosis (RAS) is indicated in patients with the onset of hypertension before the age of 30 years. (Level of evidence: B)
2.
The performance of diagnostic studies to identify clinically significant RAS is indicated in patients with the onset of severe hypertension (as defined in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood

A. Acute Intestinal Ischemia

(1) Acute Intestinal Ischemia Caused by Arterial Obstruction

(a) Diagnosis

Class I

1.
Patients with acute abdominal pain out of proportion to physical findings and who have a history of cardiovascular disease should be suspected of having acute intestinal ischemia. (Level of evidence: B)
2.
Patients who develop acute abdominal pain after arterial interventions in which catheters traverse the visceral aorta or any proximal arteries or who have arrhythmias (such as atrial fibrillation) or recent MI

A. Abdominal Aortic and Iliac Aneurysms

(1) Risk Factors

Class I

1.
In patients with AAAs, blood pressure and fasting serum lipid values should be monitored and controlled as recommended for patients with atherosclerotic disease. (Level of evidence: C)
2.
Patients with aneurysms or a family history of aneurysms should be advised to stop smoking and be offered smoking cessation interventions, including behavior modification, nicotine replacement, or bupropion. (Level of evidence: B)

(2) Aortic Aneurysm Rupture: General Recommendations

References (2)

AT Hirsch et al.
ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine and Biology, and the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). American College of Cardiology Web Site
AT Hirsch et al.
ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease [Lower Extremity, Renal, Mesenteric, and Abdominal Aortic]). American College of Cardiology Web Site

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This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org) and the American Heart Association (www.americanheart.org). Single copies of this document are available by calling 1-800-253-4636 or writing the American College of Cardiology Foundation, Resource Center, at 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Ask for reprint number 71-0349. To obtain a copy of the Executive Summary published in the March 21, 2006, issue of the Journal of the American College of Cardiology and the March 21, 2006, issue of Circulation; ask for reprint number 71-0348. To purchase bulk reprints (specify version and reprint number): Up to 999 copies, call 1-800611-6083 (US only) or fax 413-665-2671; 1,000 or more copies, call 214-706-1789, fax 214-691-6342

This document can also be found on the World Wide Web sites of the Society for Cardiovascular Angiography and Interventions (www.scai.org), Society for Vascular Medicine and Biology (www.svmb.org), Society of Interventional Radiology (www.sirweb.org), and Vascular Disease Foundation (www.vdf.org). Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. This document was approved by the American College of Cardiology Foundation Board of Trustees in October 2005 and by the American Heart Association Science Advisory and Coordinating Committee in October 2005. These recommendations have been compiled with permission of the American College of Cardiology Foundation.

^*: AAVS/SVS when Guideline initiated, now merged into SVS.

^†: Society for Vascular Medicine and Biology official representative.

^‡: Society of Interventional Radiology official representative.

^§: Society for Vascular Surgery official representative.

^¶: Society for Cardiovascular Angiography and Interventions official representative.

^**: Former Task Force member during this effort.

^††: Immediate Past Chair.

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Standards of PracticeACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

Section snippets

PREAMBLE

A. Classification of Recommendations

A. Lower-extremity PAD: General Recommendations for Diagnosis and Therapy by Clinical Presentation

A. Clinical Clues to the Diagnosis of Renal Artery Stenosis

A. Acute Intestinal Ischemia

A. Abdominal Aortic and Iliac Aneurysms

Standards of Practice
ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)