2024 ESC Guidelines on peripheral arterial disease (PAD)

The European Society of Cardiology (ESC) 2024 Guidelines for the Management of Peripheral Arterial and Aortic Diseases emphasize the crucial role of early diagnosis and intervention, particularly using the ankle-brachial index (ABI) and toe-brachial index (TBI). This blog highlights key updates from the guidelines, focusing on the latest recommendations for PAD detection and clinical management.

ABI: a non-invasive and essential diagnostic tool

The ankle-brachial index (ABI) is a simple, cost-effective, and non-invasive test that compares the systolic blood pressure at the ankle and the arm.

According to the latest ESC guidelines:

An ABI ≤0.90 is indicative of PAD, requiring further clinical evaluation and intervention.
An ABI >1.40 suggests arterial stiffness, which is often linked to conditions such as diabetes or advanced age and is associated with an increased risk of cardiovascular events and mortality.
In cases where ABI results are inconclusive, additional testing with the toe-brachial index (TBI) is recommended.

TBI: addressing the limitations of ABI

For patients with diabetes, chronic kidney disease, or medial arterial calcification, ABI measurements may be unreliable due to non-compressible arteries. In these cases, the toe-brachial index (TBI) provides a more accurate assessment. TBI measures toe pressure using laser Doppler or plethysmography, with a pathological threshold of ≤0.70 being indicative of PAD.

Additional diagnostic approaches

1. The guidelines introduce a classification system dividing peripheral arterial disease (PAD) into three main categories:

Asymptomatic PAD: Identified typically through screening.
Symptomatic PAD: Characterized by effort-related symptoms.
Chronic limb-threatening ischemia: Includes patients experiencing ischemic pain at rest.

2. The ESC guidelines also discuss the role of transcutaneous oxygen pressure (TcPO2) in assessing tissue viability:

Resting TcPO2 >30 mmHg suggests good wound healing potential.
TcPO2 <10 mmHg indicates a high risk of poor prognosis and potential limb amputation.

3. Given the high cardiovascular risk associated with PAD and aortic diseases, the guidelines highlight the importance of screening for obstructive coronary artery disease (CAD). Utilizing coronary computed tomography (CT) is recommended for its accuracy and efficiency in diagnosing CAD, which is vital for tailoring revascularization strategies and optimizing medical therapy.

4. Patients experiencing exertional limb pain but having a normal resting ABI should undergo exercise testing with post-exercise ABI measurement or exercise oximetry to diagnose lower-limb arterial stenoses. However, the guidelines note discrepancies in post-exercise ABI criteria, highlighting the need for careful interpretation to avoid false positives.

Our advanced solutions for PAD detection

At MESI, we understand the importance of reliable and efficient PAD diagnostics. Our MESI mTABLET ABI and MESI mTABLET TBI provide oscillometric-based ABI and TBI measurements, ensuring:

Automatic, accurate, and fast PAD screening with digital documentation.
Consistent results with minimal training requirements, reducing inter-operator variability.
Wireless, portable, and modular design that integrates additional diagnostic tools for comprehensive vascular assessments.

The 2024 ESC guidelines emphasize the need for proper physician training to achieve better reproducibility in ABI and TBI measurements. MESI mTABLET ABI and TBI are designed to support standardized and reproducible diagnostics, enabling healthcare professionals to detect PAD early and optimize patient outcomes.

With PAD being a strong predictor of cardiovascular disease and mortality, early and accurate detection is crucial. The 2024 ESC guidelines reaffirm ABI and TBI as fundamental diagnostic tools, with MESI’s advanced mTABLET solutions helping physicians perform fast, reliable, and digitalized arterial assessments in everyday clinical practice.