Sandbox: Peripheral Arterial Disease

Template:Peripheral Arterial Disease Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]

==2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases (PAD), in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)==

What is new in the 2017 PAD Guidelines

2011	2017
2017 Change in Recommendations:
Carotid Artery Disease
IIb - Embolic Protection Devices (EPDs)in Carotid Stenting	IIa - Embolic Protection Devices (EPDs)in Carotid Stenting
Asymptomatic 60-90% carotid stenosis
IIa - Surgery for all	IIa - Surgery for high stroke risk
IIb - Stenting as an alternative	IIa - Stenting in high surgery risk
	IIa - Stenting in average surgery risk
2017 New Recommendations:
IIb - Coronary angiography before elective carotid surgery
III - Routine prophylactic revascularization of asymptomatic carotid 70-99% stenosis in patients undergoing CABG.
2017 Change in Recommendations:
Upper Extremity Artery Disease
I - Revascularisation for symptomatic subclavian artery stenosis	IIa - Revascularisation for symptomatic subclavian artery stenosis
Subclavian stenosis revascularization
I - Endovascular first	IIa - Stenting or surgery
IIb - Revascularization for asymptomatic subclavian stenosis in patients with/planned for CABG	IIa - Revascularization for asymptomatic subclavian stenosis in patients with/planned for CABG
Renal Artery Disease
IIb - Stenting for symptomatic atherosclerotic stenosis >60%	III - Stenting for symptomatic atherosclerotic stenosis >60%
2017 New Recommendations:
Renal Artery Disease
Fibromuscular dysplasia balloon angioplasty with bailout stenting
2017 Change in Recommendations:
Lower Extremity Artery Disease (LEAD)
Aorto-iliac lesions
IIa - Primary endovascular therapy for 'TASC-D'	IIa - Surgery in aorta-iliac or -bi-femoral occlusions
	IIb - Endovascular as an alternative in experienced centres.
Infra-popliteal lesions
IIa - Endovascular first	I - Bypass using GSV
	IIa - Endovascular therapy
2017 New Recommendations:
Lower Extremity Artery Disease (LEAD)
I - Statins to improve walking distance
I - LEAD + Atrial Fibrillation (AF): Anticoagulation if CHAD-VASc >2
IIa - Angiography in Chronic limb-threatening ischaemia (CLTI) with below-the-knee lesions
IIa - Duplex screening for Abdominal Aortic Aneurysm (AAA)
IIa - In case of CABG: screen LEAD with ABI, limit vein harvesting if LEAD
IIb - Screening for LEAD in patients with coronary artery disease (CAD)
IIb - Screening for LEAD in patients with heart failure (HF)
IIb - Clopidogrel preferred over aspirin
III - Antiplatelet therapy in isolated asymptomatic LEAD
2017 New Recommendations:
Mesenteric Artery Disease
IIa - D-dimers to rule out acute mesenteric ischaemia
III - No delay for re-nuutrition in case of symptomatic Chronic Mesenteric Ischaemia