New 2017 ESC Guidelines on PAD

September is the month of Peripheral Arterial Disease awareness. Every month we try to focus on various topics which are connected to PAD, vessels or heart condition. But since the whole month is dedicated to Peripheral Arterial Disease, we will go back to basics.

What is Peripheral Arterial Disease or PAD?

Peripheral Arterial Disease (PAD), or to be more precise, LEAD (Lower Extremity Artery Disease)is narrowing of the peripheral arteries, most often due to atherosclerosis. It is caused by build-up of plaque in the arterial walls.

Who is at risk for PAD?

PAD is associated with other cardiovascular complications. Its prevalence increases with age. As the world’s populations grow older, so does the number of PAD patients.

PAD can lead to:

If the disease is not discovered early enough or treated the right way, it can have dangerous outcomes, such as heart attack, stroke, ulceration or amputation.

From asymptomatic patients to masked LEAD

Most patients with LEAD are asymptomatic, nearly 70% of the patients do not feel any pain or changes in the lower extremities. In the new ESC guidelines, the true threat for PAD disease is the group of patients who do not feel any symptoms, but they may have a severe disease. This can be due to their incapacity to move enough to reveal symptoms. This group is called “masked LEAD”.

How can be PAD detected?

The simplest way to detect PAD is with an Ankle-Brachial Index measurement, where the ratio of blood pressure from both ankles is divided with the blood pressure of the upper arm. The measurement is non-invasive and painless.

MESI contribution for PAD diagnosis

MESI has developed an automated Ankle-Brachial Index measurement, which is fast, simple and accurate. It is the quickest way to diagnose Peripheral Arterial Disease. Thanks to new technology, the ABI measurement can become the standard procedure in every primary health care. practice.

Guidelines give a meaning to our work

According to different guidelines, such as ACC/AHA, ABI measurement should be performed on all patients in the risk group (Figure 2).

New 2017 ESC guidelines emphasize ABI measurement even more. ABI measurement is not only a tool for the diagnosis of LEAD, but it is also a strong marker for atherosclerosis and CV risk detection. In addition to the basic risk group for PAD (LEAD), the patients who should have their ABI measured are also those who are at risk for LEAD because of CAD, and PADs, AAA, CKD and heart failure.

The term “masked LEAD” is also new to us. The name covers the group of patients, who do not develop the usual symptoms, due to their inability to walk for an extended period of time or have their pain masked by neuropathy. These patients are at greater risk for severe PAD.


Glossary

LEAD – Low Extremity Artery Disease
PADs – Peripheral Arterial Diseases: In new 2017 ESC guidelines PAD covers all arterial diseases, except coronary arteries and the aorta.


References

Correction to: 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017). Circulation, 135(12), pp.e790-e790.
Aboyans, V., Ricco, J., Bartelink, M., Björck, M., Brodmann, M., Cohnert, T., Collet, J., Czerny, M., De Carlo, M., Debus, S., Espinola-Klein, C., Kahan, T., Kownator, S., Mazzolai, L., Naylor, A., Roffi, M., Röther, J., Sprynger, M., Tendera, M., Tepe, G., Venermo, M., Vlachopoulos, C. and Desormais, I. (2017). 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal.