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Published by American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines · ACC/AHA Class of Recommendation and Level of Evidence
Lower extremity PAD is a common cardiovascular disease associated with an increased risk of amputation, myocardial infarction, stroke, and death. This comprehensive guideline updates the 2016 AHA/ACC PAD Guideline, providing evidence-based practices for clinical assessment, physiological testing, and interdisciplinary management—including GDMT, structured exercise, wound care, and revascularization strategies.
Key Takeaways
This document supersedes recommendations in the '2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease'.
In patients at increased risk of PAD, a comprehensive medical history and review of symptoms to assess for exertional leg symptoms, lower extremity rest pain, and lower extremity wounds or other ischemic skin changes should be performed.
In patients with history or physical examination findings suggestive of PAD, the resting ABI, with or without ankle pulse volume recordings (PVR) and/or Doppler waveforms, is recommended to establish the diagnosis.
In patients with symptomatic PAD, single antiplatelet therapy is recommended to reduce the risk of MACE.
In patients with PAD, treatment with high-intensity statin therapy is indicated, with an aim of achieving a ≥50% reduction in low-density lipoprotein cholesterol (LDL-C) level.
In patients with PAD and hypertension, a systolic blood pressure (SBP) goal of <130 mm Hg and a diastolic blood pressure target of <80 mm Hg is recommended.
Patients with PAD who smoke cigarettes or use any other forms of tobacco should be advised at every visit to quit or encouraged to maintain cessation.
In patients with chronic symptomatic PAD, SET is recommended to improve walking performance, functional status, and QOL.
In patients with functionally limiting claudication and hemodynamically significant aortoiliac or femoropopliteal disease with inadequate response to GDMT (including structured exercise), endovascular revascularization is effective to improve walking performance and QOL.
In patients with CLTI, a multispecialty care team should evaluate and provide comprehensive care with goals of complete wound healing, minimizing tissue loss, and preservation of ambulatory status.
In patients with ALI and a salvageable limb, revascularization (endovascular or surgical, including catheter-directed thrombolysis) is indicated to prevent amputation.
Clinical Topic
Lower Extremity Peripheral Artery Disease
Objectives
To provide recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia).
Target Patient Population
Patients with or at risk of developing atherosclerotic and thrombotic disease of the lower extremity arteries (PAD).
Diagnostic Criteria
Resting Ankle-Brachial Index (ABI) <= 0.90 is abnormal. In noncompressible arteries (ABI > 1.40), Toe-Brachial Index (TBI) <= 0.70 is used for diagnosis.
Target Providers
Therapeutic Area
Cardiovascular DiseaseGuideline Scope
Inclusion Criteria
Exclusion Criteria
Care Settings
Special Populations
System: ACC/AHA Class of Recommendation and Level of Evidence
Evidence Levels
Recommendation Strength
Contraindications
Monitoring Guidance
Longitudinal follow-up includes routine clinical evaluation of limb symptoms, functional status, pulse assessment, foot inspection, and ABI/duplex ultrasound surveillance after revascularization procedures.
Difficulty
advanced
Learning Paths