ACC-AHA 2024 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease
ACC/AHA｜循環器 / 末梢動脈疾患｜98 ページ｜チャンク 977｜推奨 13 件｜current
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| p.24 | 1 A | Downloaded from http://ahajournals.org by on October 7, 2026 | ||
| p.27 | 1 A | Downloaded from http://ahajournals.org by on October 7, 2026 11 In the TRA 2P–TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events–Thrombolysis In Myocardial Infarction 50) trial, the antiplatelet agent vorapaxar, an antagonist of the protease activated receptor-1, in addition to antiplatelet therapy, generally with aspirin or clopidogrel, decreased the risk of MALE, including hospitalization for ALI and lower extremity revascularization in the cohort of 3787 patients with symptomatic PAD.16 In the PAD cohort, no significant difference in MACE was observed; however, a significantly higher risk of moderate to severe bleeding was observed among those randomized to vorapaxar compared with the placebo group, thus resulting in an uncertain net clinical benefit.16 Vorapaxar is contraindicated in patients with previous stroke due to an increased risk of intracranial hemorrhage.33 12 Data supporting dual antiplatelet therapy after | ||
| p.29 | 1 A | Downloaded from http://ahajournals.org by on October 7, 2026 | ||
| p.30 | 1 A | CLINICAL STATEMENTS AND GUIDELINES | ||
| p.30 | 1 A | Downloaded from http://ahajournals.org by on October 7, 2026 | ||
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| p.37 | 1 A | and QOL (Figure 4). Mechanisms of improvement in walking performance resulting from exercise training in those with chronic symptomatic PAD are multifactorial and not fully understood.1,2 Predominant mechanisms include improvements in skeletal muscle strength and endurance (eg, mitochondrial density and activity, muscle fiber adaptations), capabilities that are known to occur in most healthy and chronic diseased individuals. There is also evidence of improvements in endothelial function, potential angiogenesis, improved blood distribution efficiency leading to potential calf blood flow increases, and a reduced local inflammatory response. Evidence does not show an increase in either microvascular or macrovascular blood flow after exercise training despite significant functional improvement.3,4 Although some evidence suggests local inflammatory adverse effects related to ischemia reperfusion injury, the evidence is strong that intermittent walking to mild or moderate pain is required to maximize the aforementioned adaptations to maximally improve walking performance.5 Although the evidence base is strongest for supervised exercise therapy (SET), other forms of structured community-based exercise programs, including homebased exercise, have been developed, and recent studies support their use in this patient population.5–15 The types of structured exercise programs for PAD are defined in Table 14. | ||
| p.42 | 1 A | Downloaded from http://ahajournals.org by on October 7, 2026 | ||
| p.45 | 1 A | interventions for common femoral artery disease vary according to the underlying anatomy (eg, bifurcation lesion versus not, involvement of branch arteries versus common femoral artery only) and the device(s) used for revascularization.33,37,39,40 Further, patients selected for endovascular common femoral artery revascularization are often those in whom wound healing would be suboptimal after a surgical approach, such as those treated with radiation therapy or previous surgery to the local area, or with severe obesity.40 Further evaluation of patient and treatment factors are necessary to better define the role of endovascular approaches to common femoral artery disease and its safety and effectiveness relative to endarterectomy. In cases where endovascular approaches to the common femoral artery adversely affect needed profunda femoris artery pathways (ie, collaterals), open surgical revascularization (ie, endarterectomy that preserves profunda femoris artery branches) is preferred. | ||
| p.47 | 1 A | Endocrinologists Internal medicine specialists Infectious disease specialists Diagnostic radiologists and other vascular imaging specialists Pharmacists Downloaded from http://ahajournals.org by on October 7, 2026 Physical medicine and rehabilitation clinicians Social workers Clinical exercise physiologists Physical and occupational therapists Nutritionists and dieticians Patients and family members (collaborate with multispecialty care team) Modified with permission from Gerhard-Herman et al.5 Copyright 2017 American Heart Association, Inc., and American College of Cardiology Foundation. CLTI indicates chronic limb-threatening ischemia; and PAD, peripheral artery disease. Recommendation-Specific Supportive Text 1 The components of multispecialty care teams | ||
| p.50 | 1 A | duit for surgical revascularization, prosthetic conduit is a secondary option for patients with CLTI without suitable saphenous veins who require surgical revascularization. Studies have shown that patients can be treated successfully with autogenous vein bypass graft22,23 or prosthetic bypass graft21,24 even after previous endovascular intervention. Studies have explored the efficacy of use of a prosthetic bypass with distal autogenous vein cuff in patients with CLTI. These circular vein patches, intended to limit narrowing where the prosthetic graft meets the target artery, have shown mixed results.52,56,57 Data supporting the use of cadaveric vein graft conduit for patients with CLTI are limited; however, this also remains an option for patients for whom a surgical revascularization strategy is undertaken and autogenous vein conduit is unavailable.25,26 Downloaded from http://ahajournals.org by on October 7, 2026 7 The goal of revascularization for CLTI is to maxi- | ||
| p.58 | 1 A | CLINICAL STATEMENTS AND GUIDELINES |