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10.1.4. Other syndromic and non-syndromic heritable thoracic aortic diseases and/or arterial disorders ........................................... 3643 10.1.4.1. Loeys–Dietz syndrome ..................................................... 3643 10.1.4.1.1. Diagnosis, clinical presentation, and natural evolution ............................................................................................... 3643 10.1.4.2. ACTA2-related heritable thoracic aortic disease .... 3645 10.2. Aortic disease associated with bicuspid aortic valves .......... 3646 10.3. Coarctation of the aorta and aortic arch variants ................ 3648 10.3.1. Coarctation of the aorta ........................................................... 3648 10.3.1.1. Diagnostic work-up ............................................................ 3648 10.3.1.2. Treatment and follow-up ................................................. 3648 10.3.2. Aortic arch anatomic variants ................................................ 3650 10.3.3. Aberrant subclavian artery and Kommerell’s diverticulum ................................................................................................... 3650 11. Polyvascular peripheral arterial disease and peripheral arterial disease in patients with cardiac diseases ..................................................... 3650

11.1. Polyvascular disease ............................................................................ 3650 11.1.1. Epidemiology and prognosis .................................................... 3650 11.1.2. Screening for atherosclerosis in other arterial territories ....................................................................................................... 3650 11.1.2.1. Screening for coronary artery disease in patients with symptomatic peripheral arterial disease ............................ 3651 11.1.2.2. Screening for peripheral arterial disease in patients with coronary artery disease ............................................................ 3651 11.1.2.3. Screening for coronary artery disease in patients with carotid stenosis ............................................................................ 3651 11.1.2.4. Screening for carotid stenosis in patients with coronary artery disease ....................................................................... 3651 11.1.3. Management of patients with polyvascular disease ....... 3651 11.2. Peripheral arterial disease and heart failure ............................. 3651 11.3. Peripheral arterial disease and AF ................................................ 3652 11.4. Peripheral arterial disease and aortic stenosis ........................ 3652 12. Key messages .................................................................................................. 3652 13. Gaps in evidence ............................................................................................ 3653 14. Sex differences ............................................................................................... 3653 15. ‘What to do’ and ‘What not to do’ messages from the guidelines .................................................................................................................. 3653 16. Evidence tables ............................................................................................... 3661 17. Data availability statement ......................................................................... 3661 18. Author information ...................................................................................... 3661 19. Appendix ........................................................................................................... 3662 20. References ........................................................................................................ 3663

Tables of Recommendations Recommendation Table 1 — Recommendations for clinical and laboratory, and for functional and quality of life, assessment in patients with peripheral arterial and aortic disease (see also Evidence Table 1) 3560 Recommendation Table 2 — Recommendations for diagnostic tests in patients with peripheral arterial disease ................................................ 3562 Recommendation Table 3 — Recommendations for imaging of the aorta (see also Evidence Table 2) .................................................................. 3565 Recommendation Table 4 — Recommendations for thoracic aortic measurements ........................................................................................................ 3566 Recommendation Table 5 — Recommendations for peripheral arterial disease screening (see also Evidence Table 3) .......................... 3568 Recommendation Table 6 — Recommendations for abdominal aortic aneurysm screening ................................................................................ 3568 Recommendation Table 7 — Recommendations for lifestyle, physical activity, and patient education (see also Evidence Table 4) 3570 Recommendation Table 8 — Recommendations for antihypertensive therapy in patients with peripheral and aortic disease ........................................................................................................................ 3571 Recommendation Table 9 — Recommendations for lipid-lowering therapy in patients with peripheral arterial and aortic diseases ....... 3572 Recommendation Table 10 — Recommendations for the medical management of patients with peripheral arterial and aortic diseases and diabetes ............................................................................................................ 3573 Recommendation Table 11 — Recommendations for diagnostic tests in patients with peripheral arterial disease and diabetes, renal failure, and wounds .............................................................................................. 3577 Recommendation Table 12 — Recommendations for imaging in patients with peripheral arterial disease ..................................................... 3577 Recommendation Table 13 — Recommendations for exercise therapy in patients with peripheral arterial disease (see also Evidence Table 5) ..................................................................................................................... 3582 Recommendation Table 14 — Recommendations for antithrombotic therapy in patients with peripheral arterial disease (see also Evidence Table 6) .............................................................................. 3582 Recommendation Table 15 — Recommendations for interventional treatment of asymptomatic and symptomatic peripheral arterial disease (general) .................................................................................................... 3584 Recommendation Table 16 — Recommendations for interventional treatment of patients with symptomatic peripheral arterial disease (per arterial bed) ................................................................................................... 3585 Recommendation Table 17 — Recommendations in patients with peripheral arterial disease: follow-up of patients with peripheral arterial disease ........................................................................................................ 3585 Recommendation Table 18 — Recommendations for the management of chronic limb-threatening ischaemia ............................. 3586 Recommendation Table 19 — Recommendations for medical treatment in patients with chronic limb-threatening ischaemia (see also Evidence Table 7) ........................................................................................ 3586 Recommendation Table 20 — Recommendations for interventional treatment of chronic limb-threatening ischaemia ................................... 3587 Recommendation Table 21 — Recommendations for follow-up in patients with chronic limb-threatening ischaemia .................................. 3587 Recommendation Table 22 — Recommendations for the management of patients presenting with acute limb ischaemia (see also Evidence Table 8) ........................................................................................ 3590 Recommendation Table 23 — Recommendations for carotid artery stenosis assessment ............................................................................................. 3590 Recommendation Table 24 — Recommendations for antithrombotic treatment in patients with carotid stenosis .............. 3592 Recommendation Table 25 — Recommendations for interventional treatment in patients with asymptomatic carotid artery stenosis ... 3594 Recommendation Table 26 — Recommendations for evaluation and medical treatment in patients with symptomatic carotid artery stenosis ...................................................................................................................... 3594 Recommendation Table 27 — Recommendations for interventions in patients with symptomatic carotid artery stenosis ........................... 3596 Recommendation Table 28 — Recommendations for follow-up in patients with carotid artery stenosis ............................................................ 3596 Recommendation Table 29 — Recommendations for the management of subclavian artery stenosis (see also Evidence Table 9) ..................................................................................................................... 3597 Recommendation Table 30 — Recommendations for diagnostic strategies for renal artery disease .................................................................. 3600 Downloaded from academic.oup.com/eurheartj/article/45/36/3538/7738955 by guest on 07 October 2026