Interpretation of 2024 ESC guidelines for the management of peripheral arterial and aortic diseases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TANG Kai ¹ ,  LUO Mingyao ^1,2,3 , SHU Chang ^1,2

1. State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Vascular Surgery, Fuwai Central China Cardiovascular Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 450046, P. R. China;
3. Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650032, P. R. China;

Corresponding author：

LUO Mingyao, Email: luomingyao@fuwai.com

Keywords：

Aortic disease; peripheral arterial disease; guideline interpretation

DOI：

10.7507/1007-4848.202410038

Video：

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In recent years, the worldwide incidence rate of peripheral arterial and aortic diseases has increased year by year, significantly increasing the cardiovascular mortality and incidence rate of the whole population. In the past, peripheral arterial and aortic diseases were often more prone to missed diagnosis and delayed treatment compared to coronary artery disease. The 2024 ESC guidelines for the management of peripheral arterial and aortic diseases for the first time combines peripheral arterial and aortic diseases, integrating and updating the 2017 guidelines for peripheral arterial disease and the 2014 guidelines for aortic disease. The aim is to provide standardized recommendations for the management of systemic arterial diseases, ensuring that patients can receive coherent and comprehensive diagnosis and treatment, thereby improving prognosis. This article interprets the main content of the guideline in order to provide reference and assistance for the clinical diagnosis and treatment of peripheral arterial and aortic diseases in China at the current stage.

Citation： TANG Kai, LUO Mingyao, SHU Chang. Interpretation of 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(1): 14-23. doi: 10.7507/1007-4848.202410038 Copy

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3.	Liu W, Yang C, Chen Z, et al. Global death burden and attributable risk factors of peripheral artery disease by age, sex, SDI regions, and countries from 1990 to 2030: Results from the Global Burden of Disease study 2019. Atherosclerosis, 2022, 347: 17-27.
4.	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
5.	Mazzolai L, Teixido-Tura G, Lanzi S, et al; ESC Scientific Document Group. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
6.	Charry D, Gouskova N, Meyer ML, et al. Arterial stiffness and contralateral differences in blood pressure: The Atherosclerosis Risk in Communities (ARIC) study. J Clin Hypertens (Greenwich), 2022, 24(7): 878-884.
7.	Ouriel K, Ae M, Metz Ce, et al. Critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery, 1982, 91(6): 686-693.
8.	Laing S, Greenhalgh RM. The detection and progression of asymptomatic peripheral arterial disease. Br J Surg, 1983, 70(10): 628-630.
9.	Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association. Circulation, 2012, 126(24): 2890-2909.
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15.	Leng GC, Fowkes FG. The Edinburgh Claudication Questionnaire: An improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. J Clin Epidemiol, 1992, 45(10): 1101-1109.
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1. 赵倩南, 王淳秀, 关绍晨, 等. 北京地区35岁及以上人群外周动脉疾病患病率特点及影响因素分析. 中华心血管病杂志, 2019, 47(12): 1000-1004.Zhao QN, Wang CX, Guan SC, et al. Prevalence characters of peripheral artery disease and associated factors among Beijing residents aged equal and above 35 years old. Chin J Cardiol, 2019, 47(12): 1000-1004.
2. GBD 2019 Peripheral Artery Disease Collaborators. Global burden of peripheral artery disease and its risk factors, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health, 2023, 11(10): e1553-e1565.
3. Liu W, Yang C, Chen Z, et al. Global death burden and attributable risk factors of peripheral artery disease by age, sex, SDI regions, and countries from 1990 to 2030: Results from the Global Burden of Disease study 2019. Atherosclerosis, 2022, 347: 17-27.
4. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
5. Mazzolai L, Teixido-Tura G, Lanzi S, et al; ESC Scientific Document Group. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
6. Charry D, Gouskova N, Meyer ML, et al. Arterial stiffness and contralateral differences in blood pressure: The Atherosclerosis Risk in Communities (ARIC) study. J Clin Hypertens (Greenwich), 2022, 24(7): 878-884.
7. Ouriel K, Ae M, Metz Ce, et al. Critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery, 1982, 91(6): 686-693.
8. Laing S, Greenhalgh RM. The detection and progression of asymptomatic peripheral arterial disease. Br J Surg, 1983, 70(10): 628-630.
9. Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association. Circulation, 2012, 126(24): 2890-2909.
10. Lindholt JS, Juul S, Fasting H, et al. Screening for abdominal aortic aneurysms: Single centre randomised controlled trial. BMJ, 2005, 330(7494): 750.
11. Cervin A, Wanhainen A, Björck M. Popliteal aneurysms are common among men with screening detected abdominal aortic aneurysms, and prevalence correlates with the diameters of the common iliac arteries. Eur J Vasc Endovasc Surg, 2020, 59(1): 67-72.
12. Sigvant B, Lundin F, Wahlberg E. The risk of disease progression in peripheral arterial disease is higher than expected: A meta-analysis of mortality and disease progression in peripheral arterial disease. Eur J Vasc Endovasc Surg, 2016, 51(3): 395-403.
13. Anand SS, Caron F, Eikelboom JW, et al. Major adverse limb events and mortality in patients with peripheral artery disease: The COMPASS Trial. J Am Coll Cardiol, 2018, 71(20): 2306-2315.
14. Chuter VH, Searle A, Barwick A, et al. Estimating the diagnostic accuracy of the ankle-brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta-analysis. Diabet Med, 2021, 38(2): e14379.
15. Leng GC, Fowkes FG. The Edinburgh Claudication Questionnaire: An improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. J Clin Epidemiol, 1992, 45(10): 1101-1109.
16. Treat-Jacobson D, McDermott MM, Bronas UG, et al. Optimal exercise programs for patients with peripheral artery disease: A scientific statement from the American Heart Association. Circulation, 2019, 139(4): e10-e33.
17. Mazzolai L, Belch J, Venermo M, et al. Exercise therapy for chronic symptomatic peripheral artery disease. Eur Heart J, 2024, 45(15): 1303-1321.
18. Fowkes FG, Price JF, Stewart MC, et al. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: A randomized controlled trial. JAMA, 2010, 303(9): 841-848.
19. Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: Factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ, 2008, 337: a1840.
20. Anand SS, Bosch J, Eikelboom JW, et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: An international, randomised, double-blind, placebo-controlled trial. Lancet, 2018, 391(10117): 219-229.
21. Liette MD, Crisologo PA, Masadeh S, et al. A prospective analysis of the SVS WIfI classification system to stratify immediate and 1-year patient outcomes. J Foot Ankle Surg, 2023, 62(4): 661-665.
22. Goode SD, Cleveland TJ, Gaines PA, et al. Randomized clinical trial of stents versus angioplasty for the treatment of iliac artery occlusions (STAG trial). Br J Surg, 2013, 100(9): 1148-1153.
23. Krankenberg H, Zeller T, Ingwersen M, et al. Self-expanding versus balloon-expandable stents for iliac artery occlusive disease: The randomized ICE rrial. JACC Cardiovasc Interv, 2017, 10(16): 1694-1704.
24. Aboyans V, Björck M, Brodmann M, et al. Questions and answers on diagnosis and management of patients with peripheral arterial diseases: A companion document of the 2017 ESC guidelines for the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018, 55(4): 457-464.
25. McQuade K, Gable D, Pearl G, et al. Four-year randomized prospective comparison of percutaneous ePTFE/nitinol self-expanding stent graft versus prosthetic femoral-popliteal bypass in the treatment of superficial femoral artery occlusive disease. J Vasc Surg, 2010, 52(3): 584-590.
26. Frank U, Nikol S, Belch J, et al. ESVM guideline on peripheral arterial disease. Vasa, 2019, 48(Suppl 102): 1-79.
27. Teichgräber U, Lehmann T, Thieme M, et al. Drug-coated balloon angioplasty of infrapopliteal lesions in patients with critical limb ischaemia: 1-year results of the APOLLO trial. Cardiovasc Intervent Radiol, 2019, 42(10): 1380-1390.
28. TASC Steering Committee; Jaff MR, White CJ, Hiatt WR, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: A supplement to the Inter-Society Consensus for the management of peripheral arterial disease (TASC Ⅱ). Vasc Med, 2015, 20(5): 465-478.
29. Boc V, Kozak M, Eržen B, et al. Prognostic factors for restenosis of superficial femoral artery after endovascular treatment. J Clin Med, 2023, 12(19): 6343.
30. Zeller T, Micari A, Scheinert D, et al. The IN. PACT DEEP clinical drug-coated balloon trial: 5-year outcomes. JACC Cardiovasc Interv, 2020, 13(4): 431-443.
31. Kennedy J, Hill MD, Ryckborst KJ, et al. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): A randomised controlled pilot trial. Lancet Neurol, 2007, 6(11): 961-969.
32. Sacco RL, Diener HC, Yusuf S, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med, 2008, 359(12): 1238-1251.
33. Aboyans V, Bauersachs R, Mazzolai L, et al. Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: A consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy. Eur Heart J, 2021, 42(39): 4013-4024.
34. Messas E, Goudot G, Halliday A, et al. Management of carotid stenosis for primary and secondary prevention of stroke: State-of-the-art 2020: A critical review. Eur Heart J Suppl, 2020, 22(Suppl M): M35-M42.
35. Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet, 2003, 361(9352): 107-116.
36. Bush CK, Kurimella D, Cross LJ, et al. Endovascular treatment with stent-retriever devices for acute ischemic stroke: A meta-analysis of randomized controlled trials. PLoS One, 2016, 11(1): e0147287.
37. Savardekar AR, Narayan V, Patra DP, et al. Timing of carotid endarterectomy for symptomatic carotid stenosis: A snapshot of current trends and systematic review of literature on changing paradigm towards early surgery. Neurosurgery, 2019, 85(2): E214-E225.
38. Hill MD, Brooks W, Mackey A, et al. Stroke after carotid stenting and endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Circulation, 2012, 126(25): 3054-3061.
39. Howard G, Roubin GS, Jansen O, et al. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: A meta-analysis of pooled patient data from four randomised trials. Lancet, 2016, 387(10025): 1305-1311.
40. Clark CE, Taylor RS, Shore AC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: A systematic review and meta-analysis. Lancet, 2012, 379(9819): 905-914.
41. Ahmed AT, Mohammed K, Chehab M, et al. Comparing percutaneous transluminal angioplasty and stent placement for treatment of subclavian arterial occlusive disease: A systematic review and meta-analysis. Cardiovasc Intervent Radiol, 2016, 39(5): 652-667.
42. Hamdan R, Guilleminot P, Leclercq T, et al. Coronary-subclavian steal syndrome causing myocardial infarction after arteriovenous fistula creation: A case report. ESC Heart Fail, 2023, 10(3): 2084-2089.
43. Duran M, Grotemeyer D, Danch MA, et al. Subclavian carotid transposition: Immediate and long-term outcomes of 126 surgical reconstructions. Ann Vasc Surg, 2015, 29(3): 397-403.
44. Modarai B, Ali T, Dourado R, et al. Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic disease of the supra-aortic trunks. Br J Surg, 2004, 91(11): 1453-1457.
45. Safian RD. Renal artery stenosis. Prog Cardiovasc Dis, 2021, 65: 60-70.
46. Johansen KL, Garimella PS, Hicks CW, et al. Central and peripheral arterial diseases in chronic kidney disease: Conclusions from a kidney disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int, 2021, 100(1): 35-48.
47. Salsano G, Salsano A, Sportelli E, et al. What is the best revascularization strategy for acute occlusive arterial mesenteric ischemia: Systematic review and meta-analysis. Cardiovasc Intervent Radiol, 2018, 41(1): 27-36.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of 2024 ESC guidelines for the management of peripheral arterial and aortic diseases

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