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• W2612416069 abstract "In this issue of CCI, SCAI is excited to deliver the updated Peripheral Arterial Disease (PAD) Appropriate Use Guidelines to help guide management of our patients with lower extremity and renal artery disease 1. This document, for SCAI members and written by SCAI members, is intended to help us all navigate “best practices”—often in the face of conflicting data—and aid in our decision-making for patients with PAD. PAD, until recently, was relatively under-recognized and undertreated. Fortunately, awareness of the impact of PAD on both mortality and quality of life has increased rapidly over the past decade. Along with increased recognition, the field of peripheral arterial intervention has grown exponentially. In the four years since the last version of this document, multiple new revascularization devices are now available, including new iterations of previous devices (e.g., atherectomy, balloons, stents) and entirely new categories of devices (e.g., drug coated balloons and peripheral drug eluting stents) 2. Smaller profile devices, technical advances, and increased experience have extended the “reach” and capabilities of the peripheral interventionalist. Radial and tibial approaches are now frequently employed, and chronic total occlusion techniques are regularly shared between the coronary and peripheral interventionalist. As the challenges of managing critical limb ischemia (CLI) have become more apparent, the National Institutes of Health sponsored BEST-CLI randomized comparison of surgical and endovascular approaches, along with several industry-sponsored below-the-knee device trials, are redefining our approach to this devastating and disabling disease 3. Multidisciplinary collaboration (CLI Teams, modeled after Heart Teams 4) have taken hold amongst forward-thinking practitioners. All of this is a step forward for our patients, but only if these new approaches and devices are used properly, by skilled and knowledgeable clinicians, and only when indicated. Innovative developments bring forth the obvious questions: What are the latest indications for intervention? What are the alternative approaches and which is best for my patient? How aggressive should I be? What skill level is required? Which devices must I be facile with and have available to me? How do I avoid using the wrong—or inappropriate—therapy for my patient? In the areas of coronary artery and structural heart disease, we in cardiology have done a terrific job—perhaps better than any other specialty in medicine—defining the outcomes and indications for management, interventional and otherwise. For this, we and our patients owe a debt of gratitude to those investigators and clinicians (and their patients) who have generated mountains of data in extremely well-conducted (often seminal) trials, as well as the real-world data emanating from large registries, such as the ACC-NCDR Cath-PCI and TVT Registries. It is also a tribute to the dedication of cardiovascular specialists, who are committed to the concepts of innovation, evidence-based medicine, and assessment of quality and outcomes. When it comes to the world of peripheral intervention, the data are more confusing and challenging. The reasons for this are myriad: the disease state itself, which varies widely in clinical presentation and pathology; the previous lack of recognition of its impact on morbidity and mortality (and thus the absence of a “burning platform”); and the fact that PAD is managed by multiple, often competing, medical and surgical specialties, making standardization and collaboration on research and clinical trials challenging. Recent multidisciplinary efforts to standardize definitions (e.g., PARC, WIFI) have helped produce consensus guidelines (e.g., the AHA/ACC PAD 2016 guidelines document developed in conjunction with SCAI 5), while multispecialty led clinical trials [e.g., BEST-CLI (Best Endovascular vs. Best Surgical Therapy in Patients With CLI trial), CLEVER (Claudication: Exercise vs. Endoluminal Revascularization study), and ERASE (Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication trial)] 3, 6, 7 promise to facilitate collaboration and ultimately enable us to generate the data required for evidence-based management. The updated PAD Appropriate Use Guidelines in this issue of CCI, as was the case with its previous version, will serve an important role in guiding decision-making for our members and their patients. The recommendations contained in this guideline statement incorporate the latest data available and, where the data are incomplete, the consensus methodology incorporated in the development of appropriateness criteria will provide a barometer for interventionalists to know that they are “doing the right thing.” It is notable that the methodology used to generate the criteria in the current document was intended to enable consensus amongst providers who routinely manage PAD; accordingly, interventionalists who are highly experienced and familiar with both the literature and real-world outcomes make up a majority of the rating panel. These select individuals are key leaders who are deeply involved in the care of patients with PAD. SCAI believes this document reflects the best current treatment recommendations, made by the best content experts, using the best consensus methodology, for our patients with PAD. We as a community of clinicians treating PAD still have much work to do to produce the evidence necessary to further validate, extend, and broaden these recommendations. In the meantime, our hope is that this document will serve our members and their patients well, and that it will improve the treatment of PAD." @default.
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• W2612416069 title "The “appropriateness” of AUC for peripheral arterial disease: The story continues…" @default.
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• W2612416069 doi "https://doi.org/10.1002/ccd.27157" @default.
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