Sandbox: Peripheral Arterial Disease: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 1: Line 1:
__NOTOC__
{{Peripheral Arterial Disease}}
{{CMG}},{{AE}}{{AKK}}
==2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases (PAD), in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)
The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)==
===Changes in Recommendations===
===What is new in the 2017 PAD Guidelines===
{| class="wikitable" style="width: 80%; text-align: justify;"
! style="width:50%" | '''2011'''
! style="width:50%" | '''2017'''
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 Change in Recommendations:}}
|-
| colspan="2" | '''Carotid Artery Disease'''
|-
| bgcolor="LemonChiffon" | IIb - Embolic Protection Devices (EPDs)in Carotid Stenting || bgcolor="LemonChiffon" | IIa - Embolic Protection Devices (EPDs)in Carotid Stenting
|-
| colspan="2" | '''Asymptomatic 60-90% carotid stenosis'''
|-
| bgcolor="LemonChiffon" | IIa - Surgery for all || bgcolor="LemonChiffon" | IIa - Surgery for high stroke risk
|-
| rowspan="2" bgcolor="LemonChiffon" | IIb - Stenting as an alternative || bgcolor="LemonChiffon" | IIa - Stenting in high surgery risk
|-
| bgcolor="LemonChiffon" | IIa - Stenting in average surgery risk
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 New Recommendations:}}
|-
| colspan="2" bgcolor="LemonChiffon" | IIb - Coronary angiography before elective carotid surgery
|-
| colspan="2" bgcolor="LightCoral" | III - Routine prophylactic revascularization of asymptomatic carotid 70-99% stenosis in patients undergoing CABG.
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 Change in Recommendations:}}
|-
| colspan="2" | '''Upper Extremity Artery Disease'''
|-
| bgcolor="LightGreen" | I - Revascularisation for symptomatic subclavian artery stenosis || bgcolor="LemonChiffon" | IIa - Revascularisation for symptomatic subclavian artery stenosis
|-
| colspan="2" | '''Subclavian stenosis revascularization'''
|-
| bgcolor="LightGreen" | I - Endovascular first || bgcolor="LemonChiffon" | IIa - Stenting or surgery
|-
| bgcolor="LemonChiffon" | IIb - Revascularization for asymptomatic subclavian stenosis in patients with/planned for CABG || bgcolor="LemonChiffon" | IIa - Revascularization for asymptomatic subclavian stenosis in patients with/planned for CABG
|-
| colspan="2" | '''Renal Artery Disease'''
|-
| bgcolor="LemonChiffon" | IIb - Stenting for symptomatic atherosclerotic stenosis >60% || bgcolor="LightCoral" | III - Stenting for symptomatic atherosclerotic stenosis >60%
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 New Recommendations:}}
|-
| colspan="2" | '''Renal Artery Disease'''
|-
| colspan="2" bgcolor="LemonChiffon" | Fibromuscular dysplasia balloon angioplasty with bailout stenting
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 Change in Recommendations:}}
|-
| colspan="2" | '''Lower Extremity Artery Disease (LEAD)'''
|-
| colspan="2" | '''Aorto-iliac lesions'''
|-
| rowspan="2" bgcolor="LemonChiffon" | IIa - Primary endovascular therapy for 'TASC-D'|| bgcolor="LemonChiffon" | IIa - Surgery in aorta-iliac or -bi-femoral occlusions
|-
| bgcolor="LemonChiffon" | IIb - Endovascular as an alternative in experienced centres.
|-
| colspan="2" | '''Infra-popliteal lesions'''
|-
| rowspan="2" bgcolor="LemonChiffon" | IIa - Endovascular first || bgcolor="LightGreen" | I - Bypass using GSV
|-
| bgcolor="LemonChiffon" | IIa - Endovascular therapy
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 New Recommendations:}}
|-
| colspan="2" | '''Lower Extremity Artery Disease (LEAD)'''
|-
| colspan="2" bgcolor="LightGreen" | I - Statins to improve walking distance
|-
| colspan="2" bgcolor="LightGreen" | I - LEAD + Atrial Fibrillation (AF): Anticoagulation if CHAD-VASc >2
|-
| colspan="2" bgcolor="LemonChiffon" | IIa - Angiography in Chronic limb-threatening ischaemia (CLTI) with below-the-knee lesions
|-
| colspan="2" bgcolor="LemonChiffon" | IIa - Duplex screening for Abdominal Aortic Aneurysm (AAA)
|-
| colspan="2" bgcolor="LemonChiffon" | IIa - In case of CABG: screen LEAD with ABI, limit vein harvesting if LEAD
|-
| colspan="2" bgcolor="LemonChiffon" | IIb - Screening for LEAD in patients with coronary artery disease (CAD)
|-
| colspan="2" bgcolor="LemonChiffon" | IIb - Screening for LEAD in patients with heart failure (HF)
|-
| colspan="2" bgcolor="LemonChiffon" | IIb - Clopidogrel preferred over aspirin
|-
| colspan="2" bgcolor="LightCoral" | III - Antiplatelet therapy in isolated asymptomatic LEAD
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 New Recommendations:}}
|-
| colspan="2" | '''Mesenteric Artery Disease'''
|-
| colspan="2" bgcolor="LemonChiffon" | IIa - D-dimers to rule out acute mesenteric ischaemia
|-
| colspan="2" bgcolor="LightCoral" | III - No delay for re-nuutrition in case of symptomatic Chronic Mesenteric Ischaemia
|-
| colspan="2" | {{Fontcolor|#FF0000|2017 New Recommendations:}}
|-
| colspan="2" | '''All Peripheral Arterial Diseases (PADs)'''
|-
| colspan="2" bgcolor="LemonChiffon" | IIa - Screening for heart failure (BNP, TTE)
|-
| colspan="2" bgcolor="LemonChiffon" | IIa - Stable PADs + other conditions requiring anticoagulants (e.g. AF): anticoagulation alone
|}
==2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)==
===Recommendations in Patients with Peripheral Arterial Diseases: Best Medical Therapy===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Smoking cessation is recommended in all patients with PADs. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Healthy diet and physical activity are recom- mended for all patients with PADs. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' Statins are recommended in all patients with PADs. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''4.''' In patients with PADs, it is recommended to reduce LDL-C to < 1.8 mmol/L (70 mg/dL) or decrease it by ≥50% if baseline values are 1.8–3.5 mmol/L (70–135 mg/dL). ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''5.''' In diabetic patients with PADs, strict glycae- mic control is recommended. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''6.''' Antiplatelet therapy is recommended in patients with symptomatic PADs. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''7.''' In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''8.''' In patients with PADs and hypertension, it is recommended to control blood pressure at < 140/90 mmHg.. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''ACEIs''' = angiotensin-converting enzyme inhibitors; '''ARBs''' = angiotensin-receptor blockers; '''LDL-C''' = low-density lipoprotein cholesterol; '''PADs''' = peripheral arterial diseases
|}
===Recommendations on Antithrombotic Therapy in Patients with Peripheral Arterial Diseases (PADs)===
{| class="wikitable" style="width:80%"
|-
| '''Carotid artery disease'''
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' In patients with symptomatic carotid stenosis, long-term SAPT is recommended. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' DAPT with aspirin and clopidogrel is recommended for at least 1 month after CAS. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' In patients with asymptomatic >50% carotid artery stenosis, long-term antiplatelet therapy (commonly low-dose aspirin) should be considered when the bleeding risk is low. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''AF''' = atrial fibrillation; '''CAS''' = carotid artery stenosis; '''CHA2DS2-VASc''' = Congestive heart failure, Hypertension, Age >_75 (2 points), Diabetes mellitus, Stroke or TIA (2 points), Vascular disease, Age 65–74years, Sex category; '''DAPT''' = dual antiplatelet therapy; '''LEAD''' = lower extremity artery disease; '''OAC''' = oral anticoagulation; '''PADs''' = peripheral arterial diseases; '''SAPT''' = single antiplatelet therapy.
|}
===Lower Extremities Artery Disease===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Long-term SAPT is recommended in symptomatic patients. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Long-term SAPT is recommended in all patients who have undergone revascularization. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' SAPT is recommended after infra-inguinal bypass surgery. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' DAPT with aspirin and clopidogrel for at least 1 month should be considered after infra-inguinal stent implantation. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' In patients requiring antiplatelet therapy, clopidogrel may be preferred over aspirin. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' Vitamin K antagonists may be considered after autologous vein infra-inguinal bypass. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' DAPT with aspirin and clopidogrel may be considered in below-the-knee bypass with a prosthetic graft. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ESC guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Because of a lack of proven benefit, antiplatelet therapy is not routinely indicated in patients with isolatedd asymptomatic LEAD. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| '''AF''' = atrial fibrillation; '''CAS''' = carotid artery stenosis; '''CHA2DS2-VASc''' = Congestive heart failure, Hypertension, Age >_75 (2 points), Diabetes mellitus, Stroke or TIA (2 points), Vascular disease, Age 65–74years, Sex category; '''DAPT''' = dual antiplatelet therapy; '''LEAD''' = lower extremity artery disease; '''OAC''' = oral anticoagulation; '''PADs''' = peripheral arterial diseases; '''SAPT''' = single antiplatelet therapy.
|}
===Antithrombotic Therapy for Peripheral Arterial Diseases (PADs) Patients Requiring Oral Anticoagulant===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.'''In patients with PADs and AF, OAC is recommended when the CHA2DS2-VASc score is ≥2. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''In patients with PADs and AF, OAC should be considered in all other patients.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.'''In patients with PADs who have an indication for OAC (e.g. AF or mechanical prosthetic valve), oral anticoagulants alone should be considered.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.'''After endovascular revascularization, aspirin or clopidogrel should be considered in addition to OAC for at least 1 month if the bleeding risk is low compared with the risk of stent/graft occlusion.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''4.'''After endovascular revascularization, OAC alone should be considered if the bleeding risk is high compared with the risk of stent/graft occlusion.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''OAC and SAPT may be considered beyond 1 month in high ischaemic risk patients or when there is another firm indication for long-term SAPT.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''AF''' = atrial fibrillation; '''CAS''' = carotid artery stenosis; '''CHA2DS2-VASc''' = Congestive heart failure, Hypertension, Age >_75 (2 points), Diabetes mellitus, Stroke or TIA (2 points), Vascular disease, Age 65–74years, Sex category; '''DAPT''' = dual antiplatelet therapy; '''LEAD''' = lower extremity artery disease; '''OAC''' = oral anticoagulation; '''PADs''' = peripheral arterial diseases; '''SAPT''' = single antiplatelet therapy.
|}
===Extracranial Carotid and Vertebral Artery Disease===
===Recommendations for Imaging of Extracranial Carotid Arteries===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.'''DUS (as first-line imaging), CTA and/or MRA are recommended for evaluating the extent and severity of extracranial carotid stenoses. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.'''When CAS is being considered, it is recommended that any DUS study be fol- lowed by either MRA or CTA to evaluate the aortic arch as well as the extra- and intracranial circulation. ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.'''When CEA is considered, it is recom- mended that the DUS stenosis estimation be corroborated by either MRA or CTA (or by a repeat DUS study performed in an expert vascular laboratory)''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> When CEA is considered, it is recommended that the DUS stenosis estimation be corroborated by either MRA or CTA (or by a repeat DUS study performed in an expert vascular laboratory).
|-
| '''CAS''' = carotid artery stenting; '''CEA''' = carotid endarterectomy; '''CTA''' = computed tomography angiography; '''DUS''' = duplex ultrasound; '''MRA''' = magnetic resonance angiography.
|}
===Recommendation on the Use of Embolic Protection Device During Carotid Stenting===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''The use of embolic protection devices should be considered in patients undergoing carotid artery stenting.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
===Recommendations for management of asymptomatic carotid artery disease===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''In ‘average surgical risk’ patients with an asymptomatic 60–99% stenosis, CEA should be considered in the presence of clinical and/or more imaging characteristics that may be associated with an increased risk of late ipsilateral stroke, provided documented perioperative stroke/death rates are <3% and the patient’s life expectancy is > 5 years.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.'''In asymptomatic patients who have been deemed ‘high risk for CEA’d and who have an asymptomatic 60–99% stenosis in the presence of clinical and/or imaging characteristicsc that may be associated with an increased risk of late ipsilateral stroke, CAS should be considered, provided documented perioperative stroke/death rates are <3% and the patient’s life expectancy is > 5 years.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''In ‘average surgical risk’ patients with an asymptomatic 60–99% stenosis in the presence of clinical and/or imaging characteristics that may be associated with an increased risk of late ipsilateral stroke, CAS may be an alternative to CEA provided documented perioperative stroke/death rates are <3% and the patient’s life expectancy is > 5 years.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| '''BP''' = blood pressure, '''CAS''' = carotid artery stenting, '''CEA''' = carotid endarterectomy
|}
===Recommendations on Revascularization in Patients with Symptomatic Carotid Disease===
===Recommendations on Revascularization in Patients with Symptomatic Carotid Disease===


Line 289: Line 29:


{| class="wikitable" style="width:80%"
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| Diagnosis
| Diagnosis
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ESC guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.'''In patients with suspected acute mesenteric ischaemia, urgent CTA is recommended.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.'''In patients with suspected acute mesenteric ischaemia, urgent CTA is recommended.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
Line 309: Line 49:
|-
|-
| CTA = computed tomography angiography
| CTA = computed tomography angiography
|}
===Recommendations for Management of Vertebral Artery Stenoses===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''In patients with symptomatic extracranial vertebral artery stenoses, revascularization may be considered for lesions >_50% in patients with recurrent ischaemic events despite opti- mal medical management.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LightCoral" | [[ESC guidelines classification scheme#Classification of Recommendations|Class III]]
|-
| bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.'''Revascularization of asymptomatic vertebral artery stenosis is not indicated, irrespective of the degree of severity.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
===Recommendations on the Management of Subclavian Artery Stenosis===
{| class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''In symptomatic patients with subclavian artery stenosis/occlusion, revascularization should be considered.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |"'''2.'''In symptomatic patients with a stenotic/ occluded subclavian artery, both revasculariza- tion options (stenting or surgery) should be considered and discussed case by case according to the lesion characteristics and patient’s risk.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon" |"'''3.''' In asymptomatic subclavian artery stenosis, revascularization:
'''-''' should be considered in the case of proximal stenosis in patients undergoing CABG using the ipsilateral internal mammary artery
'''-''' should be considered in the case of proximal stenosis in patients who already have the ipsilateral internal mammary artery grafted to coronary arteries with evidence of myocardial ischaemia
'''-''' should be considered in the case of subcla- vian artery stenosis and ipsilateral arterio-venous fistula for dialysis.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| colspan="1" style="text-align:center; background:LemonChiffon" | [[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.'''In asymptomatic subclavian artery stenosis, revascularization may be considered in the case of bilateral stenosis in order to be able to monitor blood pressure accurately.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
| '''CABG''': Coronary artery bypass grafting
|}
|}

Revision as of 15:08, 31 October 2017

Recommendations on Revascularization in Patients with Symptomatic Carotid Disease

Class I
"1.CEA is recommended in symptomatic patients with 70–99% carotid stenoses, provided the documented procedural death/ stroke rate is < 6%. (Level of Evidence: A) "
"1.When decided, it is recommended to perform revascularization of symptomatic 50–99% carotid stenoses as soon as possible, preferably within 14 days of symptom onset. (Level of Evidence: A) "
Class IIa
"1.CEA should be considered in symptomatic patients with 50–69% carotid stenoses, provided the documented procedural death/ stroke rate is < 6%.(Level of Evidence: A) "
"1.In recently symptomatic patients with a 50–99% stenosis who present with adverse anatomical features or medical comorbidities that are considered to make them ‘high risk for CEA’, CAS should be considered, provided the documented procedural death/stroke rate is < 6%.(Level of Evidence: B) "
Class IIb
"1.When revascularization is indicated in ‘average surgical risk’ patients with symptomatic carotid disease, CAS may be considered as an alternative to surgery, provided the documented procedural death/stroke rate is < 6%.(Level of Evidence: B) "
Class III
"1.Revascularization is not recommended in patients with a < 50% carotid stenosis. (Level of Evidence: A) "
Symptomatic Carotid Disease: Stroke or TIA occurring within 6 months

Recommendations on the Management of Acute Mesenteric Ischaemia

Class I
Diagnosis
"1.In patients with suspected acute mesenteric ischaemia, urgent CTA is recommended.(Level of Evidence: C) "
Class IIa
"1.In patients with suspicion of acute mesenteric ischaemia, the measurement of D- dimer should be considered to rule out the diagnosis(Level of Evidence: B) "
Treatment
Class IIa
"1.In patients with suspicion of acute mesenteric ischaemia, the measurement of D-dimer should be considered to rule out the diagnosis(Level of Evidence: B) "(Level of Evidence: B) "
"1.In patients with acute embolic occlusion of the superior mesenteric artery, both endovascular and open surgery therapy should be considered.(Level of Evidence: B) "(Level of Evidence: B) "
CTA = computed tomography angiography
Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox:_Peripheral_Arterial_Disease&oldid=1381997"