Expert panel guides treatment of arterial disease
More than 12 million Americans suffer from peripheral arterial disease (PAD), prompting the American College of Cardiology (ACC) and the American Heart Association (AHA) to release today the groundbreaking Peripheral Arterial Disease Guidelines to help physicians and all healthcare professionals better treat this alarmingly common condition.
PAD is generally defined as diseases of the arteries that supply blood to the arteries outside the heart, including those that supply the legs, feet, kidneys, and intestines. These arterial diseases can impair physical health by diminishing an individual's ability to walk. PAD can lead to amputation of the extremities, rupture of an aortic aneurysm, severe hypertension, kidney failure, as well as contribute to current rates of heart attack, stroke, and cardiovascular death.
The new Guidelines, representing best practices for managing diseases of the aorta--the body's main artery--and the arteries that supply blood to the legs, feet, kidneys, and intestines, were developed in collaboration with and approved by the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine and Biology, and the ACC/AHA Task Force on Practice Guidelines.
"These Guidelines provide a concise diagnostic and treatment guidebook for patients suffering from PAD and for physicians, physicians assistants, nurse practitioners, and nurses who are now offering care to treat them," said Alan T. Hirsch, M.D., F.A.C.C., chairman of the writing committee. "Our important collaborations with our professional partners in SVMB, SIR, SVS and SCAI make these Guidelines more valuable to all practicing health professionals. We have provided access to the best available evidence that can guide best care. A key source of the power of these recommendations is that they are so broad-based in their origin from every vascular specialty, as they attempt to reach a broad-based audience of clinicians. Everyone can use these Guidelines and a large segment of the public can benefit from them."
The PAD Guidelines strongly emphasize the fact that early detection and treatment of peripheral arterial disease can prevent disability and save lives.
"We're saying to physicians for the first time, 'Don't wait for the patient to complain to you about symptoms that they may not appreciate as hallmark signs of poor health. Ask specific questions to define high-risk groups, and initiate early therapy to maintain functional independence and decrease the risk of heart attack, stroke, and death,'" said Dr. Hirsch, an associate professor of epidemiology, medicine, and radiology at the University of Minnesota and director of Abbott Northwestern's Vascular Center in Minneapolis.
A driving force behind the Guidelines was recognition that a wide range of physicians treat peripheral arterial disease, and each brings a different set of tools and knowledge to the task, depending on background and training.
"All physicians who treat these conditions need to be aware of the latest information on diagnosis and management," said Dr. Norman R. Hertzer, emeritus chairman of the Department of Vascular Surgery at the Cleveland Clinic Foundation, Cleveland, Ohio. "These Guidelines present that information in an objective and dispassionate fashion."
Indeed, the guidelines committee took a time-tested approach to analyzing thousands of scientific studies, giving the greatest weight to well-designed randomized clinical trials, but also taking into account smaller studies and expert opinion as needed.
"We have hammered out, to the best of our abilities, recommendations for clinical practice, but we've also been very clear about the relative strengths and weaknesses of each recommendation," said Dr. Ziv J. Haskal, a professor of radiology and surgery, and director of the Division of Vascular and Interventional Radiology at New York-Presbyterian Hospital/Columbia University Medical Center, New York City. "These grayer areas mark some of the most important opportunities for future research."
Highlights of the guidelines include:
- Recommended questions and observations that can uncover hidden signs of peripheral arterial disease;
- Clinical clues that a patient may have renal artery stenosis, a narrowing of the arteries that supply blood to the kidney--and a possible cause of poorly controlled high blood pressure or kidney failure;
- Recommendations on when an aneurysm--a weakening and bulging of the arterial wall--should be treated with surgery or catheter-based therapy, as well as when "watchful waiting" is the best course;
- A critical analysis of the strengths and weaknesses of vascular imaging tests and other diagnostic methods;
- An emphasis on therapeutic choice, including the role of exercise, diet, smoking cessation, and medications, and an objective review of the benefits and drawbacks of surgical and catheter-based therapies; and
- Clinical pathways and treatment algorithms to guide clinical decision-making.
The Guidelines have been developed not just for specialists who perform the complex procedures used in the treatment of peripheral arterial disease, but also for primary care physicians, nurse practitioners, and physician assistants, all of whom make the initial diagnosis and initiate therapy.
"These Guidelines provide the busy practitioner with a series of signposts to mark the pathway to excellent vascular care," Dr. Hirsch said.
The PAD Guidelines were also endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and the Vascular Disease Foundation.
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Problems are not stop signs, they are guidelines.
~ Robert Schuller