49.1 Introduction

This section was reviewed and edited by The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Authors/Task Force Members: Helmut Baumgartner (ESC Chairperson) (Germany), Volkmar Falk (EACTS Chairperson) (Germany), Jeroen J. Bax (The Netherlands), Michele De Bonis (Italy), Christian Hamm (Germany), Per Johan Holm (Sweden), Bernard Iung (France), Patrizio Lancellotti (Belgium), Emmanuel Lansac (France), Daniel Rodriguez Muñoz (Spain), Raphael Rosenhek (Austria), Johan Sjögren (Sweden), Pilar Tornos Mas (Spain), Alec Vahanian (France), Thomas Walther (Germany), Olaf Wendler (UK), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain)

In 2011, the ESC published its first Guidelines on the Diagnosis and Management of Peripheral Arterial Diseases. This publication filled an important gap within the ESC guidelines documents compendium. Meanwhile, the ESVS released on a regular basis several guidelines documents on the management of specific localizations of arterial diseases. Both societies emphasized the need for a multidisciplinary management of these patients. When the decision was made to update these guidelines, it appeared obvious that the combination of efforts from both societies would provide the most comprehensive single document, providing updated guidelines on peripheral arterial diseases (PADs) for clinicians.

In 2011, the European Society of Cardiology (ESC) published its first ‘Guidelines on the Diagnosis and Management of Peripheral Arterial Diseases’.¹ This publication filled an important gap within the ESC Guidelines documents compendium. Meanwhile, the European Society for Vascular Surgery (ESVS) released on a regular basis several guidelines documents on the management of specific localizations of arterial diseases.

Both societies emphasized the need for a multidisciplinary management of these patients. When the decision was made to update these guidelines, it appeared obvious that the combination of efforts from both societies would provide the most comprehensive single document, providing updated guidelines on peripheral arterial diseases (PADs) for clinicians.

It is of the outmost importance that every cardiologist should be sensitive in regard to the diagnosis and management of patients with PADs, as many of them are seen and managed for concomitant cardiac conditions. In the 2011 ESC Guidelines, a specific chapter was dedicated to patients with combined coronary and peripheral artery diseases, as they mostly share the same aetiology and risk factors. In these guidelines, the Task Force made a step forward and proposed a new chapter on other cardiac conditions frequently encountered among patients with PADs. Also, as the options for use and combination of antithrombotic drugs have increased, a specific chapter has been dedicated for their use in the management of PADs.

In the following chapters in Section 49, the term ‘peripheral arterial diseases’ encompasses all arterial diseases other than coronary arteries and the aorta. This should be clearly distinguished from the term ‘peripheral artery disease’ often used to name lower extremity artery disease (LEAD). Indeed, other peripheral localizations, including the carotid and vertebral, upper extremities, mesenteric and renal arteries are also frequently affected, mainly by atherosclerosis, and complete the family of PADs. Regarding carotid and vertebral arteries, the following chapters in Section 49 cover only their extracranial segments, as specialists other than cardiologists and vascular surgeons often manage intracranial arterial diseases.

The Task Force has decided to address only PADs secondary to atherosclerosis, with a few exceptions in specific areas where non-atherosclerotic diseases are a frequent differential diagnosis (e.g. fibromuscular dysplasia in renal arteries). For other cases, the readers should always bear in mind the possibility of non-atherosclerotic conditions, and refer to specific documents. The readers are also invited to refer to the web addenda in the ESC Guidelines¹ for further information.

The ESC and the ESVS also join their determinations to provide increased medical and public awareness about PADs. Indeed, while stroke is acknowledged as a serious condition with significant burden throughout Europe, other PADs can also be as lethal and disabling. Major efforts are still necessary to sensitize healthcare providers, decision makers, and the general population about the need for earlier and more efficient prevention and management strategies for the 40 million individuals in our continent affected by PADs.^1,2

See Table 49.1.1 for general recommendations on the management of patients with PADs.