The interpretation of 2017 ESC guidelines for the diagnosis and treatment of peripheral arterial disease (lower extremity arterial disease)_Chinese Journal of Evidence-Based Medicine

Authors：

YUAN Ding ,  ZHAO Jichun , MA Yukui , WANG Tiehao , HUANG Bin , YANG Yi

Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

ZHAO Jichun, Email: zhaojc3@163.com

Keywords：

Clinical practice guideline; European Society of Cardiology; Peripheral arterial disease; Lower extremity arterial disease; Diagnosis; Treatment; Interpretation

DOI：

10.7507/1672-2531.201709079

Video：

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This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.

Citation： YUAN Ding, ZHAO Jichun, MA Yukui, WANG Tiehao, HUANG Bin, YANG Yi. The interpretation of 2017 ESC guidelines for the diagnosis and treatment of peripheral arterial disease (lower extremity arterial disease). Chinese Journal of Evidence-Based Medicine, 2017, 17(12): 1381-1387. doi: 10.7507/1672-2531.201709079 Copy

1.	Cull DL, Manos G, Hartley MC, et al. An early validation of the society for vascular surgery lower extremity threatened limb classification system. J Vasc Surg, 2014, 60(6): 1535-1541.
2.	Mills JL, Conte MS, Armstrong DG, et al. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg, 2014, 59(1): 220-234.
3.	Xu D, Zou L, Xing Y, et al. Diagnostic value of ankle-brachial index in peripheral arterial disease: a meta-analysis. Can J Cardiol, 2013, 29(4): 492-498.
4.	Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation, 2012, 126(24): 2890-2909.
5.	Tehan PE, Santos D, Chuter VH. A systematic review of the sensitivity and specificity of the toe-brachial index for detecting peripheral artery disease. Vasc Med, 2016, 21(4): 382-389.
6.	Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA, 2008, 300(2): 197-208.
7.	Collins R, Cranny G, Burch J, et al. A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease. Health Technol Assess, 2007, 11(20): 1-184.
8.	Met R, Bipat S, Legemate DA, et al. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA, 2009, 301(4): 415-424.
9.	Menke J, Larsen J. Meta-analysis: Accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease. Ann Intern Med, 2010, 153(5): 325-334.
10.	F Piepoli M. 2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts). Int J Behav Med, 2017, 24(3): 321-419.
11.	Juergens JL, Barker NW, Hines EA. Arteriosclerosis obliterans: review of 520 cases with special reference to pathogenic and prognostic factors. Circulation, 1960, 21: 188-195.
12.	Aung PP, Maxwell HG, Jepson RG, et al. Lipid-lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev, 2007, (4): CD000123.
13.	Westin GG, Armstrong EJ, Bang H, et al. Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia. J Am Coll Cardiol, 2014, 63(7): 682-690.
14.	Momsen AH, Jensen MB, Norager CB, et al. Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies. Eur J Vasc Endovasc Surg, 2009, 38(4): 463-474.
15.	Kumbhani DJ, Steg PG, Cannon CP, et al. Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. Eur Heart J, 2014, 35(41): 2864-2872.
16.	Shahin Y, Barnes R, Barakat H, et al. Meta-analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients with intermittent claudication. Atherosclerosis, 2013, 231(2): 283-290.
17.	Vlachopoulos C, Terentes-Printzios D, Aboyans V, et al. Angiotensin converting enzyme inhibitors and walking distance: Have we walked the whole distance. Atherosclerosis, 2016, 252: 199-200.
18.	Bagger JP, Helligsoe P, Randsbaek F, et al. Effect of verapamil in intermittent claudication a randomized, double-blind, placebo-controlled, cross-over study after individual dose-response assessment. Circulation, 1997, 95(2): 411-414.
19.	Wallen MP, Hall A, Dias KA, et al. Impact of beta-blockers on cardiopulmonary exercise testing in patients with advanced liver disease. Aliment Pharmacol Ther, 2017, 46(8): 741-747.
20.	Indes JE, Pfaff MJ, Farrokhyar F, et al. Clinical outcomes of 5 358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther, 2013, 20(4): 443-455.
21.	Bosiers M, Deloose K, Callaert J, et al. BRAVISSIMO: 12-month results from a large scale prospective trial. J Cardiovasc Surg (Torino), 2013, 54(2): 235-253.
22.	Ye W, Liu CW, Ricco JB, et al. Early and late outcomes of percutaneous treatment of transAtlantic inter-society consensus class C and D aorto-iliac lesions. J Vasc Surg, 2011, 53(6): 1728-1737.
23.	Goode SD, Cleveland TJ, Gaines PA. Randomized clinical trial of stents versus angioplasty for the treatment of iliac artery occlusions (STAG trial). Br J Surg, 2013, 100(9): 1148-1153.
24.	Murphy TP, Cutlip DE, Regensteiner JG, et al. Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the claudication: exercise versus endoluminal revascularization (CLEVER) study. Circulation, 2012, 125(1): 130-139.
25.	Ballotta E, Lorenzetti R, Piatto G, et al. Reconstructive surgery for complex aortoiliac occlusive disease in young adults. J Vasc Surg, 2012, 56(6): 1606-1614.
26.	Bredahl K, Jensen LP, Schroeder TV, et al. Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease. J Vasc Surg, 2015, 62(1): 75-82.
27.	Antoniou GA, Sfyroeras GS, Karathanos C, et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg, 2009, 38(5): 616-622.
28.	Dosluoglu HH, Lall P, Cherr GS, et al. Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg, 2010, 51(6): 1425-1435.
29.	Kavanagh CM, Heidenreich MJ, Albright JJ, et al. Hybrid external iliac selective endarterectomy surgical technique and outcomes. J Vasc Surg, 2016, 64(5): 1327-1334.
30.	Matsagkas M, Kouvelos G, Arnaoutoglou E, et al. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg, 2011, 25(8): 1063-1069.
31.	Lammer J, Zeller T, Hausegger KA, et al. Sustained benefit at 2 years for covered stents versus bare-metal stents in long SFA lesions: the VIASTAR trial. Cardiovasc Intervent Radiol, 2015, 38(1): 25-32.
32.	Lammer J, Zeller T, Hausegger KA, et al. Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions: the randomized VIASTAR trial (Viabahn endoprosthesis with PROPATEN bioactive surface VIA versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease). J Am Coll Cardiol, 2013, 62(15): 1320-1327.
33.	Liistro F, Grotti S, Porto I, et al. Drug-eluting balloon in peripheral intervention for the superficial femoral artery: the DEBATE-SFA randomized trial (drug eluting balloon in peripheral intervention for the superficial femoral artery). JACC Cardiovasc Interv, 2013, 6(12): 1295-1302.
34.	Schroeder H, Werner M, Meyer DR, et al. Low-dose paclitaxel-coated versus uncoated percutaneous transluminal balloon angioplasty for femoropopliteal peripheral artery disease: one-year results of the illumenate European randomized clinical trial (randomized trial of a novel paclitaxel-coated percutaneous angioplasty balloon). Circulation, 2017, 135(23): 2227-2236.
35.	Rosenfield K, Jaff MR, White CJ, et al. Trial of a paclitaxel-coated balloon for femoropopliteal artery disease. N Engl J Med, 2015, 373(2): 145-153.
36.	Geraghty PJ, Mewissen MW, Jaff MR, et al. Three-year results of the vibrant trial of viabahn endoprosthesis versus bare nitinol stent implantation for complex superficial femoral artery occlusive disease. J Vasc Surg, 2013, 58(2): 386-395.
37.	Bradbury AW, Adam DJ, Bell J, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: a survival prediction model to facilitate clinical decision making. J Vasc Surg, 2010, 51(5 Suppl): 52S-68S.
38.	Klinkert P, Post PN, Breslau PJ, et al. Saphenous vein versus PTFE for above-knee femoropopliteal bypass. A review of the literature. Eur J Vasc Endovasc Surg, 2004, 27(4): 357-362.
39.	Arvela E, Venermo M, Söderström M, et al. Outcome of infrainguinal single-segment great saphenous vein bypass for critical limb ischemia is superior to alternative autologous vein bypass, especially in patients with high operative risk. Ann Vasc Surg, 2012, 26(3): 396-403.
40.	Singh S, Armstrong EJ, Sherif W, et al. Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty. Vasc Med, 2014, 19(4): 307-314.
41.	Takahara M, Kaneto H, Iida O, et al. The influence of glycemic control on the prognosis of Japanese patients undergoing percutaneous transluminal angioplasty for critical limb ischemia. Diabetes Care, 2010, 33(12): 2538-2542.
42.	Zeller T, Baumgartner I, Scheinert D, et al. Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal arterial revascularization in critical limb ischemia: 12-month results from the in pact deep randomized trial. J Am Coll Cardiol, 2014, 64(15): 1568-1576.
43.	Teraa M, Conte MS, Moll FL, et al. Critical limb ischemia: current trends and future directions. J Am Heart Assoc, 2016, 5(2): e002938.
44.	Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007, 45 Suppl S: S5-67.
45.	Sobel M, Verhaeghe R. Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 815S-843S.
46.	Manzi M, Palena L, Cester G. Endovascular techniques for limb salvage in diabetics with crural and pedal disease. J Cardiovasc Surg (Torino), 2011, 52(4): 485-492.

1. Cull DL, Manos G, Hartley MC, et al. An early validation of the society for vascular surgery lower extremity threatened limb classification system. J Vasc Surg, 2014, 60(6): 1535-1541.
2. Mills JL, Conte MS, Armstrong DG, et al. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg, 2014, 59(1): 220-234.
3. Xu D, Zou L, Xing Y, et al. Diagnostic value of ankle-brachial index in peripheral arterial disease: a meta-analysis. Can J Cardiol, 2013, 29(4): 492-498.
4. Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation, 2012, 126(24): 2890-2909.
5. Tehan PE, Santos D, Chuter VH. A systematic review of the sensitivity and specificity of the toe-brachial index for detecting peripheral artery disease. Vasc Med, 2016, 21(4): 382-389.
6. Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA, 2008, 300(2): 197-208.
7. Collins R, Cranny G, Burch J, et al. A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease. Health Technol Assess, 2007, 11(20): 1-184.
8. Met R, Bipat S, Legemate DA, et al. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA, 2009, 301(4): 415-424.
9. Menke J, Larsen J. Meta-analysis: Accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-occlusions in peripheral arterial disease. Ann Intern Med, 2010, 153(5): 325-334.
10. F Piepoli M. 2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts). Int J Behav Med, 2017, 24(3): 321-419.
11. Juergens JL, Barker NW, Hines EA. Arteriosclerosis obliterans: review of 520 cases with special reference to pathogenic and prognostic factors. Circulation, 1960, 21: 188-195.
12. Aung PP, Maxwell HG, Jepson RG, et al. Lipid-lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev, 2007, (4): CD000123.
13. Westin GG, Armstrong EJ, Bang H, et al. Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia. J Am Coll Cardiol, 2014, 63(7): 682-690.
14. Momsen AH, Jensen MB, Norager CB, et al. Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies. Eur J Vasc Endovasc Surg, 2009, 38(4): 463-474.
15. Kumbhani DJ, Steg PG, Cannon CP, et al. Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. Eur Heart J, 2014, 35(41): 2864-2872.
16. Shahin Y, Barnes R, Barakat H, et al. Meta-analysis of angiotensin converting enzyme inhibitors effect on walking ability and ankle brachial pressure index in patients with intermittent claudication. Atherosclerosis, 2013, 231(2): 283-290.
17. Vlachopoulos C, Terentes-Printzios D, Aboyans V, et al. Angiotensin converting enzyme inhibitors and walking distance: Have we walked the whole distance. Atherosclerosis, 2016, 252: 199-200.
18. Bagger JP, Helligsoe P, Randsbaek F, et al. Effect of verapamil in intermittent claudication a randomized, double-blind, placebo-controlled, cross-over study after individual dose-response assessment. Circulation, 1997, 95(2): 411-414.
19. Wallen MP, Hall A, Dias KA, et al. Impact of beta-blockers on cardiopulmonary exercise testing in patients with advanced liver disease. Aliment Pharmacol Ther, 2017, 46(8): 741-747.
20. Indes JE, Pfaff MJ, Farrokhyar F, et al. Clinical outcomes of 5 358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther, 2013, 20(4): 443-455.
21. Bosiers M, Deloose K, Callaert J, et al. BRAVISSIMO: 12-month results from a large scale prospective trial. J Cardiovasc Surg (Torino), 2013, 54(2): 235-253.
22. Ye W, Liu CW, Ricco JB, et al. Early and late outcomes of percutaneous treatment of transAtlantic inter-society consensus class C and D aorto-iliac lesions. J Vasc Surg, 2011, 53(6): 1728-1737.
23. Goode SD, Cleveland TJ, Gaines PA. Randomized clinical trial of stents versus angioplasty for the treatment of iliac artery occlusions (STAG trial). Br J Surg, 2013, 100(9): 1148-1153.
24. Murphy TP, Cutlip DE, Regensteiner JG, et al. Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the claudication: exercise versus endoluminal revascularization (CLEVER) study. Circulation, 2012, 125(1): 130-139.
25. Ballotta E, Lorenzetti R, Piatto G, et al. Reconstructive surgery for complex aortoiliac occlusive disease in young adults. J Vasc Surg, 2012, 56(6): 1606-1614.
26. Bredahl K, Jensen LP, Schroeder TV, et al. Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease. J Vasc Surg, 2015, 62(1): 75-82.
27. Antoniou GA, Sfyroeras GS, Karathanos C, et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg, 2009, 38(5): 616-622.
28. Dosluoglu HH, Lall P, Cherr GS, et al. Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg, 2010, 51(6): 1425-1435.
29. Kavanagh CM, Heidenreich MJ, Albright JJ, et al. Hybrid external iliac selective endarterectomy surgical technique and outcomes. J Vasc Surg, 2016, 64(5): 1327-1334.
30. Matsagkas M, Kouvelos G, Arnaoutoglou E, et al. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg, 2011, 25(8): 1063-1069.
31. Lammer J, Zeller T, Hausegger KA, et al. Sustained benefit at 2 years for covered stents versus bare-metal stents in long SFA lesions: the VIASTAR trial. Cardiovasc Intervent Radiol, 2015, 38(1): 25-32.
32. Lammer J, Zeller T, Hausegger KA, et al. Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions: the randomized VIASTAR trial (Viabahn endoprosthesis with PROPATEN bioactive surface VIA versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease). J Am Coll Cardiol, 2013, 62(15): 1320-1327.
33. Liistro F, Grotti S, Porto I, et al. Drug-eluting balloon in peripheral intervention for the superficial femoral artery: the DEBATE-SFA randomized trial (drug eluting balloon in peripheral intervention for the superficial femoral artery). JACC Cardiovasc Interv, 2013, 6(12): 1295-1302.
34. Schroeder H, Werner M, Meyer DR, et al. Low-dose paclitaxel-coated versus uncoated percutaneous transluminal balloon angioplasty for femoropopliteal peripheral artery disease: one-year results of the illumenate European randomized clinical trial (randomized trial of a novel paclitaxel-coated percutaneous angioplasty balloon). Circulation, 2017, 135(23): 2227-2236.
35. Rosenfield K, Jaff MR, White CJ, et al. Trial of a paclitaxel-coated balloon for femoropopliteal artery disease. N Engl J Med, 2015, 373(2): 145-153.
36. Geraghty PJ, Mewissen MW, Jaff MR, et al. Three-year results of the vibrant trial of viabahn endoprosthesis versus bare nitinol stent implantation for complex superficial femoral artery occlusive disease. J Vasc Surg, 2013, 58(2): 386-395.
37. Bradbury AW, Adam DJ, Bell J, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL) trial: a survival prediction model to facilitate clinical decision making. J Vasc Surg, 2010, 51(5 Suppl): 52S-68S.
38. Klinkert P, Post PN, Breslau PJ, et al. Saphenous vein versus PTFE for above-knee femoropopliteal bypass. A review of the literature. Eur J Vasc Endovasc Surg, 2004, 27(4): 357-362.
39. Arvela E, Venermo M, Söderström M, et al. Outcome of infrainguinal single-segment great saphenous vein bypass for critical limb ischemia is superior to alternative autologous vein bypass, especially in patients with high operative risk. Ann Vasc Surg, 2012, 26(3): 396-403.
40. Singh S, Armstrong EJ, Sherif W, et al. Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty. Vasc Med, 2014, 19(4): 307-314.
41. Takahara M, Kaneto H, Iida O, et al. The influence of glycemic control on the prognosis of Japanese patients undergoing percutaneous transluminal angioplasty for critical limb ischemia. Diabetes Care, 2010, 33(12): 2538-2542.
42. Zeller T, Baumgartner I, Scheinert D, et al. Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal arterial revascularization in critical limb ischemia: 12-month results from the in pact deep randomized trial. J Am Coll Cardiol, 2014, 64(15): 1568-1576.
43. Teraa M, Conte MS, Moll FL, et al. Critical limb ischemia: current trends and future directions. J Am Heart Assoc, 2016, 5(2): e002938.
44. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007, 45 Suppl S: S5-67.
45. Sobel M, Verhaeghe R. Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 815S-843S.
46. Manzi M, Palena L, Cester G. Endovascular techniques for limb salvage in diabetics with crural and pedal disease. J Cardiovasc Surg (Torino), 2011, 52(4): 485-492.

Chinese Journal of Evidence-Based Medicine

The interpretation of 2017 ESC guidelines for the diagnosis and treatment of peripheral arterial disease (lower extremity arterial disease)

Abstract Full text Figures/Tables Video References Cited by

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