Peripheral Artery Disease

ACCF/AHA Pocket Guideline November 2011

Management of Patients With

Peripheral Artery Disease
(Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)
Adapted from the 2005 ACCF/AHA Guideline and the 2011 ACCF/AHA Focused Update
Developed in Collaboration With the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for VascularMedicine, and Society for Vascular Surgery

© 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc. The following material was adapted from the 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease Circulation 2011; 124:2020-2045 and the 2005 ACC/AHA guidelines for the management of patients withperipheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) Circulation 2006; 113:e463-e654. This pocket guideline is available on the World Wide Web sites of the American College of Cardiology (cardiosource.org) and the American Heart Association (my.americanheart.org). For copies of this document, please contact Elsevier Inc. Reprint Department, e-mail:reprints@elsevier.com; phone: 212-633-3813; fax: 212-633-3820. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier’s permission department at healthpermissions@elsevier.com.

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Contents
1. Introduction...................................................................................................3 2. Patient History and Physical Examination: Fundamental Principles............................................................................................. 6 3. Evaluation and Treatment of Patients With, or at Risk for, PAD ........................................................................................9 4. LowerExtremity Arterial Disease.........................................................11
A. Claudication ....................................................................................................11 B. Critical Limb Ischemia (UPDATED) ................................................................25 C. Acute Limb Ischemia......................................................................................28 D. Surveillance for Patients After Lower Extremity Revascularization.............30 E. Ankle-Brachial Index, Toe-Brachial Index, and Segmental Pressure Examination (UPDATED) .................................................................31 F. Smoking Cessation (UPDATED) ......................................................................33 G. Antithrombotic andAntiplatelet Therapy (UPDATED) ..................................33 Lower Extremity

5. Renal Arterial Disease ..............................................................................35
A. Clinical Indications .........................................................................................35 B. Diagnostic Methods........................................................................................38 C. Indications for Revascularization of Patients with Hemodynamically Significant RAS .................................................................39 D. Treatment Methods: Medical, Endovascular, and Surgical...........................42 Renal

6. Mesenteric Arterial Disease....................................................................45
A. Acute Intestinal Ischemia...............................................................................45 B. Acute Nonocclusive Intestinal Ischemia ........................................................46 C. Chronic Intestinal Ischemia ............................................................................48

Mesenteric

7. Aneurysms of the Abdominal Aorta, Its Branch Vessels, and the Lower Extremities...