Long-Term Follow-Up and Management of PAD

During a Monday morning session at ISET 2023, Dr. Herbert Aronow, president of the Society for Vascular Medicine, discussed long-term goals following endovascular therapy for peripheral arterial disease (PAD). These goals include prevention of clinical events (major adverse cardiovascular events [MACE], major adverse limb events [MALE]) and monitoring for symptom recurrence/disease progression (clinical surveillance, serial noninvasive imaging). He presented statistics on the risk of MACE and MALE with symptomatic PAD, and the risk of MACE and MALE following revascularization for lower-extremity PAD from the Compass and Voyager PAD trials.

Dr. Aronow then presented ways to prevent MACE and MALE, such as risk factor and lifestyle modification (diet, smoking cessation, exercise), antithrombotic therapy (antiplatelet and anticoagulant agents), statins/PCSK9 inhibitors, and RAAS Inhibitors. An article from Shalaeva EV, et al in the European Journal for Preventive Cardiology in 2017 showed that of patients who were compliant—those who followed all recommendations, including over 80% medication adherence, healthy diet, smoking cessation, and physical exercise 30 minutes per day—2.6% had 1-year postoperative mortality (vs 25.5% of noncompliant patients), none had ischemic stroke (vs 4.9% of noncompliant patients), and 2.6% had amputation of 1 or 2 toes (vs 15.7% of noncompliant patients). He also presented statistics for the other prevention measures, showing them to be effective.

Regarding monitoring for symptom recurrence/disease progression, Dr. Aronow focused on regular clinical follow-up, which includes a comprehensive history and focused physical exam, as well as appropriate noninvasive imaging.