Questions and answers on diagnosis and management of patients with Peripheral Arterial Diseases: a companion document of the 2017 ESC Guidelines for the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Björck, Martin; Brodmann, Marianne; Czerny, Martin; Naylor, A.R.; Tendera, Michał; Vlachopoulos, Charalambos; Ricco, Jean‐Baptiste; Widimský, Petr; Kolh, Philippe; Dick, Florian; Céniga, Melina Vega de; Sievert, Horst; Sulženko, Jakub; Windecker, Stephan; Aboyans, Victor; Agewall, Stefan; Barbato, Emanuele; Bueno, Héctor; Coca, António; Collet, Jean‐Philippe; Coman, Ioan Mircea; Dean, Veronica; Delgado, Victoria; Fitzsimons, Donna; Gaemperli, Oliver; Hindricks, Gerhard; Iung, Bernard; Jüni, Peter; Katus, Hugo A.; Knuuti, Juhani; Lancellotti, Patrizio; Leclercq, Christophe; McDonagh, Theresa; Piepoli, Massimo F; Ponikowski, Piotr; Richter, Dimitrios J; Roffi, Marco; Shlyakhto, Evgeny; Simpson, Iain; Zamorano, José Luís

doi:10.1093/eurheartj/ehx499

Cited by 100 publications

(179 citation statements)

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“…Laparoscopic aorto-bifemoral bypass surgery, compared with conventional open surgery, its complications are similar or fewer [10,11], the postoperative hospital stay is shorter [10,12], and expenditure is lesser [13]. Retrospective cohort analysis showed that the 5-year primary and secondary patency rates were as high as 83% and 97% [14].…”

Section: Discussionmentioning

confidence: 99%

Comparing the safety and efficacy of endovascular treatment versus bypass surgery for infrarenal aortic occlusion: a single-center experience

Wang

Shao

Qiu

et al. 2019

Preprint

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Background: Infrarenal aortic occlusion (IAO) is a complete occlusion of infrarenal aorta, which is the most complicated and severe subclass of aortoiliac occlusive disease (AIOD). The first-line treatment for IAO is bypass surgery due to its favorable patency rate. As endovascular technique advances, several retrospective studies have reported their endovascular experience for IAO. However, whether endovascular treatment(EVT) is comparable to bypass surgery for IAO required further study. This research was to study the safety and efficacy of EVT for IAO compared to bypass surgery. Methods: From 2003 to 2017, 44 consecutive patients with IAO was treated with EVT(n=16) or aortofemoral bypass surgery(n=28). The therapeutic strategy depended on patient’s will and state of health. Demographics, comorbidity, mortality, complication rate, and symptom-free survival proportion was compared by T-tests or chi-square test, to illustrate the safety and efficacy of EVT and bypass surgery. Results:The demographics and pre-operative Rutherford classification equally distributed in the two groups(P>0.05). As for technical success, comorbidities, mortality, complication rate, and Rutherford classification after procedures, clinical success, no significant difference was observed(P>0.05). The median post-procedure hospital stay was 4 days in the EVT group and was significantly shorter than that of the bypass, which was 11 days(P<0.05). As for short-term and long-term results, the 1-year, 3-year, and 5-year the cumulative symptom-free survival rates were 85.7%, 85.7% and 85.7% in the EVT group, 100%, 94.1% and 80.7% in the aortofemoral bypass group.There was no significant difference insymptom-free survival ratebetween the two groups according to log-rank test (P=0.92) Conclusions: The safety and efficacy of EVT were comparable to that of anatomic bypass surgery for IAO . EVT could be a feasible option for IAO.

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Section: Discussionmentioning

confidence: 99%

Comparing the safety and efficacy of endovascular treatment versus bypass surgery for infrarenal aortic occlusion: a single-center experience

Wang

Shao

Qiu

et al. 2019

Preprint

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“…receptor antagonist clopidogrel over aspirin, if symptomatic (I A). 1 Yet, anticoagulation is only recommended in patients with co-morbidities that require anticoagulant therapy independent of the LEAD. 1 The guidelines of the AHA/ACC recommend antiplatelet therapy also in asymptomatic LEAD patients with an ankle brachial index ≤ 0.9 (IIa C recommendation), and they suggest SAPT with aspirin or clopidogrel without preferences in symptomatic LEAD patients (I A recommendation).…”

Section: Current Guideline Recommendationsmentioning

confidence: 99%

“…1 Yet, anticoagulation is only recommended in patients with co-morbidities that require anticoagulant therapy independent of the LEAD. 1 The guidelines of the AHA/ACC recommend antiplatelet therapy also in asymptomatic LEAD patients with an ankle brachial index ≤ 0.9 (IIa C recommendation), and they suggest SAPT with aspirin or clopidogrel without preferences in symptomatic LEAD patients (I A recommendation). 5 Furthermore, they add that the overall benefit of vorapaxar in addition to antiplatelet therapy in symptomatic LEAD patients is uncertain (IIb B recommendation), and they recommend against the use of anticoagulants (III A recommendation).…”

Section: Current Guideline Recommendationsmentioning

confidence: 99%

“…P; Kucher, Nils; Lund, Lars H; Niessner, Alexander; Semb, Anne Grete; Schmidt, Thomas A; Sulzgruber, Patrick; Tamargo, Juan; Vitale, Cristiana; Wassmann, Sven; Aboyans, Victor; Lewis, Basil S (2020) 1,3 ; Domenico D´Amario 4 ; Stefan Agewall 5 ; Dan Atar 5 ; Iris Baumgartner 6 ; Claudio Borghi 7 ; Marco De Carlo 8 ; Heinz Drexel 9 ; Juan Carlos Kaski 10 ; Keld P Kjeldsen 11 ; Nils Kucher 12 ; Lars H Lund 1 ;…”

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confidence: 99%

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Antithrombotic therapy and major adverse limb events in patients with chronic lower extremity arterial disease: systematic review and meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases

Savarese

Reiner

Uijl

et al. 2019

European Heart Journal - Cardiovascular Pharmacotherapy

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Aims The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of antithrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD. Methods and results Study inclusion criteria were: enrolment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single-antiplatelet therapy (SAPT); dual-antiplatelet therapy vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of ≥200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30 447 patients were included. Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization [relative risk (RR) 0.89, 95% confidence interval (CI) 0.83–0.94] and limb amputation (RR 0.63, 95% CI 0.46–0.86), as well as stroke (RR 0.82, 95% CI 0.70–0.97). There was no statistically significant effect on the risk of myocardial infarction (RR 0.98, 95% CI 0.87–1.11), all-cause (RR 0.93, 95% CI 0.86–1.01), and cardiovascular death (RR 0.97, 95% CI 0.86–1.08). Risk of major bleeding increased (RR 1.23, 95% CI 1.04–1.44). Conclusion In patients with LEAD, more intense antithrombotic therapy reduces the risk of limb amputation and revascularization as well as stroke with an increase in the risk of bleeding events.

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“…As a result of population growth, global ageing and diabetes, in the last decade the number of peripheral arterial disease (PAD) patients has increased by 23 % (1). Even though it is estimated to affect over 200 million people worldwide, individuals in early stages of PAD either do not experience or under-report claudication (lower extremity pain) symptoms, thus PAD frequently remains undetected and untreated (2).…”

Section: Introductionmentioning

confidence: 99%

Depression and neuroticism in patients with peripheral arterial disease: a cross-sectional study

Tóth-Vajna

Balog

et al. 2019

Preprint

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Background: The aim of this study was to examine the relationship of depressive symptomatology and personality traits with peripheral arterial disease (PAD). Methods: The sample comprised of 300 individuals (Mage=65.3±8.7 years, 61.0% female) recruited from the offices of 33 general practitioners. Based on at-rest ankle-brachial index (ABI) values and claudication symptoms, four subsamples were formed: clear PAD-positive, clear PAD-negative, ABI-negative but symptomatic, and a non-compressible-artery group. The concurrent role of depression (assessed by a shortened version of the Beck Depression Inventory), and five-factor personality traits (measured with the Big Five Inventory) in predicting PAD status was examined using multinomial logistic regression analysis – controlled for sex, age, hypertonia, diabetes, smoking, hazardous drinking, and body mass index. Results: Depressive symptomatology was significant in predicting peripheral arterial disease status even after controlling for both traditional risk factors and personality traits. Among the Big Five personality traits, neuroticism showed the most consistent relationship with PAD – independently of depression. Conclusions: Patients with PAD – even those with asymptomatic forms of the disease – are at higher risk for suffering from depression compared to individuals without PAD, independently of neuroticism, other Big Five personality dimensions or traditional risk factors for cardiovascular diseases.

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Questions and answers on diagnosis and management of patients with Peripheral Arterial Diseases: a companion document of the 2017 ESC Guidelines for the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Cited by 100 publications

References 0 publications

Comparing the safety and efficacy of endovascular treatment versus bypass surgery for infrarenal aortic occlusion: a single-center experience

Comparing the safety and efficacy of endovascular treatment versus bypass surgery for infrarenal aortic occlusion: a single-center experience

Depression and neuroticism in patients with peripheral arterial disease: a cross-sectional study

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