p.5 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2024;149:e1313–e1410. DOI: 10.1161/CIR.0000000000001251 June 11, 2024 e1317

1 INTRODUCTION

1.1 Methodology and Evidence Review

The recommendations listed in this guideline are, whenever possible, evidence based. An initial extensive evidence review, which included literature derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline, was conducted from October 2020 to June 2022. Key search words included but were not limited to the following: acute limb ischemia, angioplasty, ankle-brachial index, anticoagulation, antiplatelet therapy, antithrombotic therapy, atypical leg symptoms, blood pressure lowering, bypass graft/bypass grafting/surgical bypass, cilostazol, claudication/ intermittent claudication, critical limb ischemia/chronic limb-threatening ischemia, diabetes, diagnostic testing, endovascular therapy, exercise rehabilitation/exercise therapy/exercise training/supervised exercise, foot care, hybrid approach, lipid lowering, lower extremity/ foot wound/ulcer, medical management, open revascularization, open surgery, percutaneous therapy, peripheral artery disease/peripheral arterial disease/peripheral vascular disease/lower extremity arterial disease, smoking/smoking cessation, statin, stenting, thrombolysis, and vascular surgery. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables when appropriate. The final evidence tables are included in the Online Data Supplement and summarize the evidence used by the writing committee to formulate recommendations. References selected and published in the present document are intended to be representative and not all-inclusive.

1.2 Organization of the Writing Committee

The writing committee consisted of clinicians, including general and interventional cardiologists, interventional radiologists, vascular medicine specialists, vascular surgeons, a vascular nurse, a cardiovascular nurse practitioner, wound care experts, an exercise physiologist, a podiatrist, lay stakeholder representatives, as well as clinical researchers in the field of vascular disease. The writing committee included representatives from the ACC, AHA, American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American Podiatric Medical Association (APMA), Association of Black Cardiologists (ABC), Society for Cardiovascular Angiography and Interventions (SCAI), Society for Vascular Medicine (SVM), Society for Vascular Nursing (SVN), Society for Vascular Surgery (SVS), Society of Interventional Radiology (SIR), and Vascular & Endo- vascular Surgery Society (VESS). Appendix 1 of the current document lists writing committee members’ comprehensive and relevant RWI.

On April 6, 2023, a writing committee member disclosed their participation on an industry board of directors. When this was reviewed using specific AHA/ACC RWI policy for guidelines, performance measures, and data standards, it was not considered to represent a nonpermissible relationship with industry under the policy. However, the member stepped down as an author of the guideline, and the AHA/ACC RWI policy was revised to include service on the board of directors for industry as a nonpermissible relationship. In accordance with the AHA/ACC RWI policy, the member did not draft clinical practice recommendations or vote to approve or reject recommendations where their RWI applied. The member stepped down before the guideline writing committee reviewed and approved the manuscript for submission to the Joint Committee, the AHA Science Advisory and Coordinating Committee, the AHA Executive Committee, the ACC Clinical Policy and Approval Committee, the ACC Science and Quality Committee, and the collaborating organizations for consideration of endorsement.

1.3 Document Review and Approval

The Joint Committee appointed a peer review committee to review the document. The peer review committee comprised individuals nominated by the ACC, AHA, and the collaborating organizations. Reviewers’ RWI information was distributed to the writing committee and is published in this document (Appendix 2). This document was approved for publication by the governing bodies of the ACC and the AHA and was endorsed by the AACVPR, APMA, ABC, SCAI, SVM, SVN, SVS, SIR, and VESS.

1.4 Scope of the Guideline

Lower extremity peripheral artery disease (PAD) is a common CVD that is estimated to affect 10 to 12 million individuals in the United States who are >40 years of age and is associated with significant morbidity, mortality, and QOL impairment.1 It has been estimated that at least 113 million people and perhaps as many as 236 million people worldwide have PAD, although prevalence estimates vary considerably.2–4 The purpose of this document is to provide a contemporary guideline for the diagnosis and management of patients with lower extremity PAD. This document supersedes recommendations in the “2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease.”5 The scope of this guideline is limited to atherosclerotic and thrombotic disease of the lower extremity arteries (PAD) and includes disease of

Downloaded from http://ahajournals.org by on October 7, 2026