Endorsed by: the European Stroke Organisation (ESO) Authors/Task Force Members: Michal Tendera (Chairperson) (Poland), Victor Aboyans (Co-Chairperson) (France), Marie-Louise Bartelink (The Netherlands), Iris Baumgartner (Switzerland), Denis Cle ́ment (Belgium), Jean-Philippe Collet (France), Alberto Cremonesi (Italy), Marco De Carlo (Italy), Raimund Erbel (Germany), F. Gerry R. Fowkes (UK), Magda Heras (Spain), Serge Kownator (France), Erich Minar (Austria), Jan Ostergren (Sweden), Don Poldermans (The Netherlands), Vincent Riambau (Spain), Marco Roffi (Switzerland), Joachim Ro ̈ ther† (Germany), Horst Sievert (Germany), Marc van Sambeek (The Netherlands), Thomas Zeller (Germany).

ESC Guidelines on the Diagnosis and Treatment of Peripheral Artery Diseases

2D
: two-dimensional
3D
: three-dimensional
ABI
: ankle–brachial index
ACAS
: Asymptomatic Carotid Atherosclerosis Study
ACCF
: American College of Cardiology Foundation
ACE
: angiotensin-converting enzyme
ACS
: acute coronary syndrome
ACST
: Asymptomatic Carotid Surgery Trial
ALI
: acute limb ischaemia
ASTRAL
: Angioplasty and Stenting for Renal Artery Lesions trial
BASIL
: Bypass versus Angioplasty in Severe Ischaemia of the Leg
BOA
: Dutch Bypass Oral Anticoagulants or Aspirin
CABG
: coronary artery bypass grafting
CAD
: coronary artery disease
CAPRIE
: Clopidogrel versus Aspirin in Patients at Risk for Ischaemic Events
CAPTURE
: Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events
CARP
: Coronary Artery Revascularization Prophylaxis
CAS
: carotid artery stenting
CASPAR
: Clopidogrel and Acetylsalicylic Acid in Bypass Surgery for Peripheral Arterial Disease
CASS
: Coronary Artery Surgery Study
CAVATAS
: CArotid and Vertebral Artery Transluminal Angioplasty Study
CEA
: carotid endarterectomy
CHARISMA
: Clopidogrel for High Atherothrombotic Risk and Ischaemic Stabilization, Management and Avoidance
CI
: confidence interval
CLEVER
: Claudication: Exercise Versus Endoluminal Revascularization
CLI
: critical limb ischaemia
CORAL
: Cardiovascular Outcomes in Renal Atherosclerotic Lesions
COURAGE
: Clinical Outcomes Utilization Revascularization and Aggressive Drug Evaluation
CPG
: Committee for Practice Guidelines
CREST
: Carotid Revascularization Endarterectomy vs. Stenting Trial
CT
: computed tomography
CTA
: computed tomography angiography
CVD
: cardiovascular disease
DECREASE-V
: Dutch Echocardiographic Cardiac Risk Evaluation
DRASTIC
: Dutch Renal Artery Stenosis Intervention Cooperative Study
DSA
: digital subtraction angiography
DUS
: duplex ultrasound/duplex ultrasonography
EACTS
: European Association for Cardio-Thoracic Surgery
EAS
: European Atherosclerosis Society
ECST
: European Carotid Surgery Trial
EPD
: embolic protection device
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EUROSCORE
: European System for Cardiac Operative Risk Evaluation
EVA-3S
: Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis
EXACT
: Emboshield and Xact Post Approval Carotid Stent Trial
GALA
: General Anaesthesia versus Local Anaesthesia for Carotid Surgery
GFR
: glomerular filtration rate
GRACE
: Global Registry of Acute Coronary Events
HbA1c
: glycated haemoglobin
HDL
: high-density lipoprotein
HOPE
: Heart Outcomes Prevention Evaluation
HR
: hazard ratio
IC
: intermittent claudication
ICSS
: International Carotid Stenting Study
IMT
: intima–media thickness
ITT
: intention to treat
LDL
: low-density lipoprotein
LEAD
: lower extremity artery disease
MACCEs
: major adverse cardiac and cerebrovascular events
MDCT
: multidetector computed tomography
MONICA
: Monitoring of Trends and Determinants in Cardiovascular Disease
MRA
: magnetic resonance angiography
MRI
: magnetic resonance imaging
NASCET
: North American Symptomatic Carotid Endarterectomy Trial
ONTARGET
: Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
OR
: odds ratio
PAD
: peripheral artery diseases
PARTNERS
: Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival
PCI
: percutaneous coronary intervention
PET
: positron emission tomography
PRO-CAS
: Predictors of Death and Stroke in CAS
PTA
: percutaneous transluminal angioplasty
RAAS
: renin–angiotensin–aldosterone system
RADAR
: Randomized, Multicentre, Prospective Study Comparing Best Medical Treatment Versus Best Medical Treatment Plus Renal Artery Stenting in Patients With Haemodynamically Relevant Atherosclerotic Renal Artery Stenosis
RAS
: renal artery stenosis
RCT
: randomized controlled trial
REACH
: Reduction of Atherothrombosis for Continued Health
RR
: risk ratio
SAPPHIRE
: Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy
SCAI
: Society for Cardiovascular Angiography and Interventions
SIR
: Society of Interventional Radiology
SPACE
: Stent-Protected Angioplasty versus Carotid Endarterectomy
SPARCL
: Stroke Prevention by Aggressive Reduction in Cholesterol Levels Study
STAR
: Stent Placement in Patients With Atherosclerotic Renal Artery Stenosis and Impaired Renal Function
SSYLVIA
: Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries
SVMB
: Society for Vascular Medicine and Biology
TASC
: TransAtlantic Inter-Society Consensus
TIA
: transient ischaemic attack
UEAD
: upper extremity artery disease
VA
: vertebral artery

Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes but are complements for textbooks and cover the ESC Core Curriculum topics. Guidelines and recommendations should help the physicians to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible physician(s).

A large number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.

Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for diagnosis, management, and/or prevention of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular treatment options were weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . …

https://www.siapav.it/pdf/ESC%20Guidelines.pdf

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC).

Epidural anesthesia and analgesia. Their role in postoperative outcome.

https://www.jvascsurg.org/article/0741-5214(86)90073-X/pdf

Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions.

Global vascular guidelines on the management of chronic limb-threatening ischemia

https://www.jvascsurg.org/article/S0741-5214(02)75197-5/pdf

High-risk carotid endarterectomy: fact or fiction.

Acute renal failure has been observed in patients undergoing angiography in which a hypertonic triiodinated contrast medium is used. To ascertain the incidence of renal dysfunction and the clinical risk factors, we did a prospective study in which creatinine clearance was measured before and immediately after 120 arteriographic procedures. Thirty-seven patients (31%) sustained a significant reduction in creatinine clearance after arteriography. No specific risk factor could be determined. Our findings, however, indicate that patients with preexisting renal insufficiency or diabetes mellitus are not at a higher risk for sustaining a fall in creatinine clearance after angiography. (JAMA1985;253:1001-1004)

Renal dysfunction after arteriography.

• A total of 362 polytetrafluoroethylene (PTFE) grafts were implanted in patients as vascular substitutes in a variety of vascular reconstructive procedures. A total of 184 were used in femoropopliteal bypass operations. Cumulative patency rates showed 74% patency at the end of the first year of observation and 58% after two and three years. Seventeen grafts were used for femorotibial bypasses, with a cumulative patency rate of 40.4% after one year. Ninety-eight grafts were implanted in the upper or lower extremity to serve as vascular access for hemodialysis. For this group, the cumulative one-year patency rate was 83%. Sixty-three additional grafts were implanted in various other anatomic locations. Based on this experience, the PTFE graft seems to be a promising and versatile vascular prosthesis, although it should be used cautiously. (Arch Surg114:673-677, 1979)

The Expanded Polytetrafluoroethylene Graft: Three Years' Experience With 362 Grafts

http://www.uhmc.sunysb.edu/surgery/jjr-cardiovasc.pdf

Fabio Giron

Papers

High-risk carotid endarterectomy: fact or fiction.

Renal dysfunction after arteriography.

The Expanded Polytetrafluoroethylene Graft: Three Years' Experience With 362 Grafts

Combined coronary artery bypass and carotid endarterectomy: long-term results.

Coronary and carotid operations under prospective standardized conditions: incidence and outcome.