2017ESC Guidelines on the Diagnosis and …

1 2017 ESC Guidelines on the Diagnosis andTreatment of Peripheral arterial Diseases,in collaboration with the European Societyfor Vascular Surgery (ESVS)Document covering atherosclerotic disease of extracranial carotidand vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and treatment of PeripheralArterial Diseases of the European Society of Cardiology (ESC) andof the European Society for Vascular Surgery (ESVS)Authors/Task Force Members: Victor Aboyans* (ESC Chairperson) (France),Jean-Baptiste Ricco*1(Co-Chairperson) (France), Marie-Louise E. L. Bartelink (TheNetherlands), Martin Bjo rck1(Sweden), Marianne Brodmann (Austria),Tina Cohnert1(Austria), Jean-Philippe Collet (France), Martin Czerny (Germany),* Corresponding authors: Victor Aboyans, Department of Cardiology CHRU Dupuytren Limoges, 2 Avenue Martin Luther King, 87042 Limoges, : 33 5 55 05 63 10, Fax: 335 55 05 63 34, Email: Jean-Baptiste Ricco, Department of Vascular Surgery, University Hospital, rue de la Miletrie, 86021 Poitiers, France.

2 Tel: 33 549443846, Fax: 33 5 49 50 05 50, Email: Committee for Practice Guidelines (CPG) and National Cardiac Societies (NCS) document reviewers: listed in the Appendix1 Representing the European Society for Vascular Surgery (ESVS)2 Representing the European Stroke Organisation (ESO)ESC entities having participated in the development of this document:Associations:European Association of Preventive Cardiology (EAPC), European Association of Cardiovascular Imaging (EACVI), European Association of PercutaneousCardiovascular Interventions (EAPCI).Councils:Council for Cardiology Practice (CCP), Council on Cardiovascular Primary Care (CCPC), Council on Hypertension (CHT).Working Groups:Atherosclerosis and Vascular Biology, Cardiovascular Pharmacotherapy, Cardiovascular Surgery, Peripheral Circulation, content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only.

3 No commercial use is authorized. No part of theESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to OxfordUniversity Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available atthe time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recom-mendations or Guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.

4 Health professionals are encour-aged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic ortherapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate andaccurate decisions in consideration of each patient s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient s caregiver. Nor dothe ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or Guidelines issued by the competentpublic health authorities, in order to manage each patient s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.

5 It is also thehealth professional s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of article has been co-published with permission in theEuropean Heart Journal[DOI: ] on behalf on the European Society of Cardiology andEuropeanJournal of Vascular and Endovascular Surgery[DOI: ] on behalf of the European Society for Vascular Surgery. All rights reserved in respect ofEuropeanHeart Journal,VCEuropean Society of Cardiology 2017. The articles are identical except for minor stylistic and spelling differences in keeping with each journal s style. Either cita-tions can be used when citing this permissions please Heart Journal (2017)00,1 60 ESC from Region Skane useron 18 January De Carlo (Italy), Sebastian Debus1(Germany), Christine Espinola-Klein(Germany), Thomas Kahan (Sweden), Serge Kownator (France),Lucia Mazzolai (Switzerland), A.

6 Ross Naylor1(UK), Marco Roffi (Switzerland),Joachim Ro ther2(Germany), Muriel Sprynger (Belgium), Michal Tendera (Poland),Gunnar Tepe (Germany), Maarit Venermo1(Finland), Charalambos Vlachopoulos(Greece), Ileana Desormais (France)Document Reviewers: Petr Widimsky (ESC Review Coordinator) (Czech Republic), Philippe Kolh (ESVSR eview Coordinator) (Belgium), Stefan Agewall (Norway), He ctor Bueno (Spain), Antonio Coca (Spain),Gert J. De Borst1(The Netherlands), Victoria Delgado (The Netherlands), Florian Dick1(Switzerland),Cetin Erol (Turkey), Marc Ferrini (France), Stavros Kakkos1(Greece/UK), Hugo A. Katus (Germany),Juhani Knuuti (Finland), Jes Lindholt1(Denmark), Heinrich Mattle2(Switzerland), Piotr Pieniazek(Poland), Massimo Francesco Piepoli (Italy), Dierk Scheinert (Germany), Horst Sievert (Germany),Iain Simpson (UK), Jakub Sulzenko (Czech Republic), Juan Tamargo (Spain), Lale Tokgozoglu (Turkey),Adam Torbicki (Poland), Nikolaos Tsakountakis (Greece), Jose Tu~n on (Spain), Melina Vega de Ceniga1(Spain), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain)The disclosure forms of all experts involved in the development of these Guidelines are available on theESC website Addenda and Questions and Answers companion documents of these Guidelines are available at.

7 Background information and detailed discussion of the data that have provided the basis for the rec-ommendations see # CardioMed Textbook ChapterWeb Peripheral arterial diseases Carotid artery disease Vertebral artery disease Upper extrem-ity artery disease Mesenteric artery disease Renal artery disease Lower extremity artery disease Multisite artery diseaseTable of .. Antithrombotic treatment in carotid artery disease .. Antithrombotic therapy in lower extremity artery disease .. Antithrombotic therapy after Antithrombotic drugs after endovascular therapy forlowerextremityarterydisease .. Patients with lower extremity artery disease andconcomitantcoronaryarterydisease .. Antithrombotic therapy in lower extremity artery GuidelinesDownloaded from Region Skane useron 18 January Antithrombotic therapy after endovascular Extracranial carotid and vertebral artery disease .

8 Management of vertebral artery disease .. Pharmacotherapy to decrease walking impairment .. Revascularization for intermittent claudication .. Management strategy for intermittent claudication .. Chronic limb-threatening ischaemia severity and Management of patients with Multisite artery disease : epidemiology and impact prognosis.. Screening for and management of multisite artery disease .. Peripheral arterial diseases in patients presentingwithcoronaryarterydisease .. Coronary artery disease in patients presenting withperipheralarterialdiseases .. Other peripheral localizations in patients withperipheralarterialdiseases ..4112. Cardiac conditions in peripheral arterial diseases .. Heart failure and peripheral arterial diseases.

9 Heart failure in patients with peripheral arterial diseases . Peripheral arterial diseases in patients with heart failure .. Peripheral arterial diseases and atrial fibrillation.. Antithrombotic treatment in patients with Peripheral arterial diseases and valvular heart disease .. Peripheral arterial diseases and vascular access site .. and acronymsAAAA bdominal aorta aneurysmABIA nkle-brachial indexACASA symptomatic Carotid Atherosclerosis StudyACEIsAngiotensin-converting enzyme inhibitorsACSA cute coronary syndromeACSRSA symptomatic carotid atherosclerosis riskof strokeACSTA symptomatic Carotid Surgery TrialACTA symptomatic Carotid TrialAFAtrial fibrillationAMERICAA ggressive detection and Management of theExtension of atherothrombosis in high Riskcoronary patients In comparison with standard ofCare for coronary AtherosclerosisARBsAngiotensin-receptor blockersARRA bsolute risk reductionASTRALA ngioplasty and stenting for renal artery lesionsBASILB ypass versus angioplasty in severe ischaemia ofthe legESC Guidelines3 Downloaded from Region

10 Skane useron 18 January Endovascular vs. Best Surgical Therapy inPatients with Critical Limb IschaemiaBMTBest medical therapyBPBlood pressureCABGC oronary artery bypass graftingCADC oronary artery diseaseCAPRIEC lopidogrel versus Aspirin in Patients at Risk ofIschaemic EventsCAPTUREC arotid ACCULINK/ACCUNET Post-ApprovalTrial to Uncover Rare EventsCARESSC lopidogrel and Aspirin for the Reduction ofEmboli in Symptomatic carotid StenosisCASPARC lopidogrel and Acetylsalicylic Acid in BypassSurgery for Peripheral arterial diseaseCASC arotid artery stentingCCAC ommon carotid arteryCEAC arotid endarterectomyCFAC ommon femoral arteryCHA2DS2-VAScCongestive heart failure, Hypertension, Age >_75 (2points), Diabetes mellitus, Stroke or TIA (2 points)