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Review
. 2024 Jun 1;53(6):afae114.
doi: 10.1093/ageing/afae114.

New Horizons in Peripheral Artery Disease

John S M Houghton  1   2   3 , Athanasios N Saratzis  1   2   3 , Rob D Sayers  1   2   3 , Victoria J Haunton  4
Affiliations
Review

New Horizons in Peripheral Artery Disease

John S M Houghton et al. Age Ageing. .

Abstract

Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent claudication, whilst chronic limb-threatening ischaemia (CLTI), the end stage of PAD, presents with rest pain and/or tissue loss. PAD is an age-related condition present in over 10% of those aged ≥65 in high-income countries. Guidelines regarding definition, diagnosis and staging of PAD and CLTI have been updated to reflect the changing patterns and presentations of disease given the increasing prevalence of diabetes. Recent research has changed guidelines on optimal medical therapy, with low-dose anticoagulant plus aspirin recommended in some patients. Recently published randomised trials highlight where bypass-first or endovascular-first approaches may be optimal in infra-inguinal disease. New techniques in endovascular surgery have increased minimally invasive options for ever more complex disease. Increasing recognition has been given to the complexity of patients with CLTI where a high prevalence of both frailty and cognitive impairment are present and a significant burden of multi-morbidity and polypharmacy. Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams.

Keywords: chronic limb-threatening ischaemia; cognitive dysfunction; frailty; older people; peripheral artery disease; vascular surgical procedures.

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Conflict of interest statement

RDS is the National Chair of the Vascular Clinical Reference Group (CRG) and a National Specialty Advisor for vascular services—both roles for NHS England.

Figures

Figure 1
Figure 1
Association of risk factors with pattern of arterial disease (reproduced with permission from Diehm et al. 2006) [17].
Figure 2
Figure 2
TASC classification for aorto-iliac arterial disease (reproduced with permission from Norgren et al. 2007) [48].
Figure 3
Figure 3
TASC classification for femoro-popliteal arterial disease (reproduced with permission from Norgren et al. 2007) [48].
See this image and copyright information in PMC

References

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MeSH terms