2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Aboyans, Victor; Ricco, Jean‐Baptiste; Bartelink, Marie-Louise; Björck, Martin; Brodmann, Marianne; Cohnert, Tina; Collet, Jean‐Philippe; Czerny, Martin; Carlo, Marco De; Debusa, Sebastian; Espinola‐Klein, Christine; Kahan, Thomas; Kownator, Serge; Mazzolai, Lucia; Naylora, A Ross; Roffi, Marco; Rotherb, Joachim; Sprynger, Muriel; Tendera, Michał; Tepe, Gunnar; Venermoa, Maarit; Vlachopoulos, Charalambos; Desormais, Iléana

doi:10.1016/j.rec.2017.12.014

Cited by 221 publications

(352 citation statements)

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“…International guidelines advise initial management with lifestyle and risk factor modification, and best medical therapy to prevent progression of PAD. Strong evidence exists for the benefit of exercise therapy, particularly in the form of a supervised exercise programme (SEP), in improving walking distances.…”

Section: Introductionmentioning

confidence: 99%

Effect of footplate neuromuscular electrical stimulation on functional and quality-of-life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial

Babber

Ravikumar

Onida

et al. 2020

British Journal of Surgery

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Background Supervised exercise programmes for intermittent claudication have poor access and limited compliance. Neuromuscular electrical stimulation (NMES) may be an effective alternative. A proof‐of‐concept study and RCT were conducted. Methods In study 1, eligible patients underwent baseline assessment; treadmill testing for initial (ICD) and maximum (MCD) claudication distance; EuroQoL Five Dimensions five‐level instrument (EQ‐5D‐5L™) and Intermittent Claudication Questionnaire (ICQ) assessment; and measurement of ultrasound haemodynamics of the superficial femoral artery. After familiarization with the NMES device, participants underwent a 30‐min session of stimulation with concomitant recording of haemodynamic measures at 15 min, and after device cessation. Measurements were repeated after 6 weeks of daily use of NMES. In study 2, consecutive patients underwent baseline assessment before online randomization to a supervised exercise programme only, or adjunctive NMES treatment for 6 weeks, followed by repeat measurements. Results Study 1 (20 patients) showed a significant improvement in MCD (46 per cent; P < 0·001) and ICD (71 per cent; P < 0·001). The RCT (42 patients) showed a significant adjunctive benefit of NMES in ICD (46 per cent; P = 0·014). Improvements were seen in the ICQ (9 points; P = 0·009) and EQ‐5D‐5L™ (P = 0·007) in study 1, and there was a significant adjunctive benefit of NMES on the ICQ score in patients who did supervised exercise (11·2 points; P = 0·031). Blood volume flow and time‐adjusted mean velocity increased significantly with the device on (P < 0·050). Overall, NMES compliance exceeded 95 per cent. Conclusion Footplate NMES significantly improved walking distance in patients with intermittent claudication when used independently and also as an adjunct to supervised exercise. Registration number: trial 1, NCT02436200; trial 2, NCT02429310 (http://www.clinicaltrials.gov).

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Section: Introductionmentioning

confidence: 99%

Effect of footplate neuromuscular electrical stimulation on functional and quality-of-life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial

Babber

Ravikumar

Onida

et al. 2020

British Journal of Surgery

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“…Although in CLI, limb salvage operation is strongly recommended, current PAD guidelines do not openly address the issue of nonindex leg treatment. The 2016 AHA/ACC guidelines discourage “preventive interventions” in the claudicate population and point out that only approximately 10% of symptomatic PAD limbs will progress to CLI.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of mirror lesions in lower extremity arterial disease

Kiesz

Góra

Kolarczyk-Haczyk

et al. 2019

Cathet Cardio Intervent

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Objective: The aim of this study was to investigate the clinical relevance of bilateral peripheral arterial disease (PAD) patterns.Background: No prior study has evaluated the clinical significance of symmetrical lesion patterns, particularly the coexistence of same-level significant plaques in both lower extremities ("mirror lesions"). Methods:We conducted a single-facility, primary data analysis involving 225 patients with symptomatic PAD.Results: Eighty-two percent of the patients had bilateral lesions: 14.2% had femoropopliteal, 38.7% had infrapopliteal, and 27.1% had both femoropopliteal and infrapopliteal lesions. The lesions were found in the exact same arteries bilaterally in 24.9% of the patients, while 26.7% had a local mirror pattern limited to the femoropopliteal (13.7%) or infrapopliteal (12.9%) arteries.Having a lesion in an artery was a risk factor for occlusive disease of the corresponding artery on the other side. Patients presenting with critical limb ischemia (CLI) had a history of resting pain (17%), ulceration/gangrene (13%), or prior amputation (26%) of the contralateral limb. Patients with significant bilateral disease had unilateral falsenegative ABI results in 11.6% of the cases. The arterial Doppler study results were unilaterally false-negative in 19.6% and bilaterally false-negative in 2.8% of the patients.Conclusions: Patients with known peripheral arterial disease need to have both limbs fully evaluated and monitored, even in cases with negative screening results. Mirror angiographic imaging is common and often accompanied by symptoms of claudication. Unilateral ischemia is a strong risk factor for contralateral disease. Patients with CLI are at high risk for occlusive lesions of the nonindex limb. K E Y W O R D Sankle-brachial index, critical limb ischemia, duplex Doppler ultrasonography, fluoroscopic angiography, peripheral arterial disease

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“…Evidence shows that home-based exercise improves pain-free walking distance by up to 180 m compared to no exercise [11,12]. This is the reason why current practice guidelines recommend exercise training (supervised or home-based) as the first line of treatment in patients with intermittent claudication, superseding vasodilator drugs [13]. However, even patients undergoing revascularization procedures should be referred for inclusion in cardiovascular rehabilitation programmes, especially following surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Gender specific differences in peripheral artery disease and their impact on cardiovascular rehabilitation -the experience of a Romanian Rehabilitation Hospital

Comşa¹,

Pharmacy²,

Gușetu³

et al. 2018

Balneo

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Introduction. As the prevalence of peripheral artery disease (PAD) is increasing in developing countries, so are the healthcare and socio-economic costs it brings about. This particular form of atherosclerotic disease is very much age-dependent, and along with the increase in life-expectancy, the lasts decades have seen a sharp rise in PAD prevalence in women. Knowledge regarding genderspecific aspects of the disease are scarce. This has a negative effect on overall outcomes of female PAD patients. Aim. This research aimed to identify gender peculiarities of PAD and evaluate their impact on cardiovascular rehabilitation. Material and methods. This was a retrospective observational study of 104 PAD patients (73 men and 31 women) admitted in 2016 to the Cardiology department of the Rehabilitation Hospital Cluj-Napoca. Demographic, clinical and biological parameters were recorded, as well as the treatment/rehabilitation regimens prescribed. The subjects were divided into to groups according to gender. Statistical analysis was done using the student t-test for unequal variances, hi-square test and the stepwise method for multivariate analysis. Results. The female group had a higher prevalence of diabetes mellitus (45% vs 33%, p=ns), but men were more likely smokers (74% vs 51%-p=0.017). Women had higher median total cholesterol values (p=0.006) and lower HDL-cholesterol levels (p=0.033). More than half of the female patients were already experiencing symptoms of critical limb ischemia on admission (57%), while intermittent claudication was predominant with men (66%). Multivariate analysis identified identified female gender (p=0.028) and ABI (p<0.0001) as sole independent predictors for the severity of the disease. Revascularization using percutaneous techniques was the preferred option for women (35% vs 27%), while surgery was performed more often in men (38% vs 29%)-p=ns. Home-based exercise training was indicated on discharge for more than half of the male group while only 30% of women had physical rehabilitation as a first line of treatment. Discussion. Our research offered similar findings to older studies regarding the genderspecific profile of PAD women, showing they are less exposed to smoking but more likely to experience metabolic disorders. Women had higher rates of critical limb ischemia on admission, suggesting a more advanced disease. Because of a more stable disease in men, this category benefited to a greater extent from exercise training compared to women. Conclusion. Peripheral artery disease has specific gender-related differences that in women have an important impact on both diagnosis and management, impeding rehabilitation and full social reintegration.

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2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Cited by 221 publications

References 0 publications

Effect of footplate neuromuscular electrical stimulation on functional and quality-of-life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial

Effect of footplate neuromuscular electrical stimulation on functional and quality-of-life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial

Clinical significance of mirror lesions in lower extremity arterial disease

Gender specific differences in peripheral artery disease and their impact on cardiovascular rehabilitation -the experience of a Romanian Rehabilitation Hospital

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