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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2497-2604. [PMID: 38752899 DOI: 10.1016/j.jacc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1313-e1410. [PMID: 38743805 DOI: 10.1161/cir.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Behrooz L, Abumoawad A, Rizvi SHM, Hamburg NM. A modern day perspective on smoking in peripheral artery disease. Front Cardiovasc Med 2023; 10:1154708. [PMID: 37187787 PMCID: PMC10175606 DOI: 10.3389/fcvm.2023.1154708] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Peripheral artery disease (PAD) is associated with increased risk of cardiovascular morbidity and mortality, poor functional status, and lower quality of life. Cigarette smoking is a major preventable risk factor for PAD and is strongly associated with a higher risk of disease progression, worse post-procedural outcomes, and increased healthcare utilization. The arterial narrowing due to atherosclerotic lesions in PAD leads to decreased perfusion to the limbs and can ultimately cause arterial obstruction and limb ischemia. Endothelial cell dysfunction, oxidative stress, inflammation, and arterial stiffness are among the key events during the development of atherogenesis. In this review, we discuss the benefits of smoking cessation among patients with PAD and the use of smoking cessation methods including pharmacological treatment. Given that smoking cessation interventions remain underutilized, we highlight the importance of incorporating smoking cessation treatments as part of the medical management of patients with PAD. Regulatory approaches to reduce the uptake of tobacco product use and support smoking cessation have the potential to reduce the burden of PAD.
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Affiliation(s)
- Leili Behrooz
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Abdelrhman Abumoawad
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Syed Husain M. Rizvi
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Naomi M. Hamburg
- Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Section of Vascular Biology, Boston Medical Center, Boston, MA, United States
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 63:602-612. [DOI: 10.1016/j.ejvs.2021.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/07/2021] [Accepted: 12/28/2021] [Indexed: 01/15/2023]
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5
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Rebuffet C, Gillois P, Joly M, Satger B, Seinturier C, Pernod G. Evaluation of socio-economic insecurity in peripheral artery disease patients. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:108-113. [PMID: 33990284 DOI: 10.1016/j.jdmv.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
The social and economic environment has become a major determinant of cardiovascular health. The objective of our study was to assess socio-economic insecurity in patients with symptomatic PAD. The PRECAR study was a non-interventional prospective cohort study. Patients were recruited from the Vascular Medicine and Surgery Departments of Grenoble-Alpes University Hospital or during a consultation as part of the therapeutic education program "On the move! Better understanding and better living with arterial disease". The analysis of socio-economic and environmental data was based on the EPICES score (a reliable index used to measure individual deprivation) and INSEE parameters (level of education and socio-professional category). Cardiovascular risk factors were also recorded. 150 patients with symptomatic PAD were included between November 2017 and June 2018. 84% were men. In our population 54% (CI95% 45.7 - 62.1) were in a precarious situation compared to 40% (CI95% 39.8 - 40.2) in the general population, according to the EPICES score (P<0.001). Levels of education were low and patients with a baccalaureate or higher education degree were under-represented. Executives, intellectuals and intermediate professions were also under-represented in the PAD population. This data opens new perspectives on the social characterisation of patients that may contribute to improving the outcomes of patients with peripheral vascular disease.
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Affiliation(s)
- C Rebuffet
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - P Gillois
- Department of Biostatistics, Grenoble-Alpes University Hospital, Grenoble, France; University Grenoble-Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France
| | - M Joly
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - B Satger
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - C Seinturier
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - G Pernod
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France; University Grenoble-Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France.
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Peters CML, Lodder P, de Vries J, Steunenberg SL, Veen EJ, de Groot HGW, Ho GH, van der Laan L. Two-year Outcome of Quality of Life and Health Status for the Elderly with Chronic Limb-threatening Ischemia. Clin Interv Aging 2020; 15:2383-2395. [PMID: 33376314 PMCID: PMC7765754 DOI: 10.2147/cia.s272078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In elderly patients with chronic limb-threatening ischemia (CLTI), there is little scientific understanding of the long-term changes of quality of life (QoL) and health status (HS) after treatment. The primary goal of this study was to provide long-term QoL and HS results for elderly CLTI patients after therapy. Treatments consisted of endovascular revascularization, surgical revascularization, or conservative treatment. Furthermore, the aim of this study was to identify the distinctive trajectories of QoL and HS. Patients and Methods CLTI patients aged ≥70 years were included in a prospective observational cohort study with a two-year follow-up. The WHOQOL-BREF was used to asses QoL. The 12-Item Short Form Health Survey was used to measure HS. The QoL and HS scores were compared to the scores in the general elderly Dutch population. Latent class trajectory analysis was used. Results A total of 195 patients were included in this study. After two years, in all treatment groups patients showed significantly higher physical QoL score compared to baseline and there was no significant difference with the corresponding values in the elderly Dutch population. In the latent class trajectory analysis, there were no overlapping risk factors for poorer QoL or HS. Conclusion This study shows that QoL levels in surviving elderly CLTI patients in the long-term do not differ from the corresponding values for elderly in the general population. There were no disparities in sociodemographic, clinical and treatment characteristics associated with poorer QoL and HS. This study was carried out to encourage further analysis of the influence of biopsychosocial characteristics on QoL and HS in elderly CLTI patients.
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Affiliation(s)
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Elisabeth-TweeSteden Hospital Tilburg University, Tilburg, The Netherlands
| | | | - Eelco J Veen
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Cardiovascular Science, UZ Leuven - University Hospitals, Leuven, Belgium
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Affiliation(s)
- Ellen K Brinza
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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Hernandez NV, Ramirez JL, Khetani SA, Spaulding KA, Gasper WJ, Hiramoto J, Lindqvist D, Wolkowitz OM, Hills NK, Grenon SM, Zahner GJ. Depression severity is associated with increased inflammation in veterans with peripheral artery disease. Vasc Med 2018; 23:445-453. [PMID: 30035700 DOI: 10.1177/1358863x18787640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study examines the association between depressive symptoms and inflammatory markers in peripheral artery disease (PAD) to better understand the mechanistic relationship between depression and PAD. A cross-sectional sample of 117 patients with PAD (97% male, 76% Caucasian) was recruited from the San Francisco Veterans Affairs Medical Center. Patients were categorized into three subgroups based upon current depressive symptom severity, as defined by Patient Health Questionnaire-8 scores: no symptoms (score of 0-4, n = 62), mild symptoms (score of 5-9, n = 33), and moderate/severe symptoms (score ≥ 10, n = 22). Serum levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-alpha (TNF-α) were assayed and log-transformed for multivariable analysis. To decrease the possibility of Type 1 errors, inflammatory markers were standardized and summed to create a total inflammatory score. In a multivariable analysis controlling for demographics, PAD severity, and atherosclerotic risk factors, mild and moderate/severe depressive symptoms were predictive of a higher total inflammatory score when compared to the group with no symptoms (mild symptoms p = 0.04, moderate/severe symptoms p = 0.007). Exploratory multivariable analyses of individual inflammatory markers found IL-6 levels were significantly higher in the moderate/severe symptoms group ( p = 0.006) than in the no symptoms group. Moreover, hs-CRP and ICAM-1 trended upwards with increasing depression severity. TNF-α was not associated with depression severity. We conclude that depressive symptom severity was independently associated with greater inflammation in PAD. Future research should examine the strength and directionality of this association through larger prospective cohort studies, as well as investigate the pathophysiological mechanisms responsible.
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Affiliation(s)
- Natalie Vm Hernandez
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Joel L Ramirez
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Sukaynah A Khetani
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.,2 Vascular Surgery Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kimberly A Spaulding
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.,2 Vascular Surgery Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Warren J Gasper
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.,2 Vascular Surgery Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jade Hiramoto
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Lindqvist
- 3 Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.,4 Department of Clinical Sciences, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
| | - Owen M Wolkowitz
- 3 Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Nancy K Hills
- 5 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - S Marlene Grenon
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.,2 Vascular Surgery Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Greg J Zahner
- 1 Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
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Hammad TA, Smolderen KG, Spertus JA, Jones PG, Shishehbor MH. Associations of exercise ankle-brachial index, pain-free walking distance and maximum walking distance with the Peripheral Artery Questionnaire: Finding from the PORTRAIT PAD Registry. Vasc Med 2018; 24:32-40. [PMID: 29992849 DOI: 10.1177/1358863x18785026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An exercise ankle-brachial index (ABI) test can provide further insight into the functional significance of peripheral artery disease (PAD). The variability in its use, associated patient factors and its relation to patients' symptoms are unknown. From the international PORTRAIT registry, we identified 1131 patients with PAD. We fit a hierarchical logistic regression model, adjusting for patient factors, country and site, to examine predictors of and variation in ordering exercise ABI testing. We also examined the associations between test components and health status as quantified by the Peripheral Artery Questionnaire (PAQ) using semi-parametric regression methods. Testing was ordered in 22% in the United States versus 80% in the Netherlands and 90% in Australia. Testing was likely to be performed if the patient was male, younger, had typical symptoms and a higher resting ABI, with substantial variability across sites (median odds ratio=5.9, 95% CI: 3.2-19.5). Adjusting for country and site, the resting ABI and all exercise ABI metrics were associated with the PAQ Physical Limitation score. In addition, important components of the test, namely time to onset of claudication, pain-free walking distance (PFWD), and maximum walking distance (MWD), were also associated with PAQ Symptoms and Summary scores. More importantly, even after adjusting for resting ABI, a patient with a post-exercise ABI of 0.29 (25th percentile), compared to 0.61 (75th percentile), achieved 4.4 (95% CI: 0.4-8.4, p=0.031) points less on the PAQ Physical Limitation score. Exercise ABI test use is remarkably variable, and less used in the United States. Its data, specifically PFWD and MWD, might help in objectively assessing the impact of PAD on patients' functioning and quality of life.
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Affiliation(s)
- Tarek A Hammad
- 1 Department of Medicine, Division of Cardiology, the University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Kim G Smolderen
- 2 Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO, USA
| | - John A Spertus
- 2 Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO, USA
| | - Philip G Jones
- 2 Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO, USA
| | - Mehdi H Shishehbor
- 3 Harrington Heart & Vascular Institute, Vascular Center, University Hospitals of Cleveland, Cleveland, OH, USA
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