Guidelines of the European Society for Vascular Medicine
Peripheral arterial diseases guidelines
Sigrid Nikol (Germany)
Nikol presented the peripheral arterial disease guidelines from the European Society for Vascular Medicine. The mission of this work was to homogenize the management of this group of patients who are at a high risk for cardiovascular events, to improve their management, and to introduce new and rational diagnostic and therapeutic options with proven efficacy. The existing guidelines were written by cardiologists, interventional radiologists, and vascular surgeons; however, the European Society for Vascular Medicine wants to create guidelines prepared by angiologists. The provision of care for vascular patients is nonhomogenous, and the guidelines should cover all of the different facilities and knowledge from different countries. Currently, the S3 guidelines for the management of peripheral arterial occlusive disease (PAOD), which was prepared by the German Society of Angiology, are being translated from German to English. The document will then be sent to national societies of vascular medicine (members of European Society for Vascular Medicine) for endorsement and review by the guidelines committee in November 2016; the publication is planned for Vasa. The European Society for Vascular Medicine plans to improve the treatment of PAOD include a European Society for Vascular Medicine training program for peripheral interventions and European Society for Vascular Medicine Position paper and campaign: awareness for PAOD.
Patrick Carpentier (France)
Carpentier presented Raynaud’s guidelines for primary care with 13 recommendations covering the definition and nomenclature, history and examination, associated conditions of primary and secondary Raynaud’s phenomenon, investigations, such as blood tests, referral to secondary care, and management (lifestyle, drugs, and surgery). The definition of Raynaud’s phenomenon is cold-induced ischemic attacks of the extremities that are manifested by transient reversible digital color changes; the terms primary and secondary Raynaud’s phenomenon should be used in place of the terms disease and syndrome. As for the management or Raynaud’s phenomenon, lifestyle modification is an effective way to control attacks, and it is necessary to avoid triggers, such as the cold, and to wear warm clothes and stop smoking. If lifestyle modifications alone fail, then nifedipine is the recommended first-line treatment. More than half of the recommendations are level C; therefore, the evidence base needs to increase.
Guidelines of the American College of Rheumatology
American College of Rheumatology’s criteria for Takayasu’s disease
Ahmed Hatri and Rachida Guermaz (Algeria)
Takayasu’s disease is a vasculitis of large and medium vessels with an unknown etiology. The disease has two phases: a systemic inflammatory phase and a scleral phase, which is the phase responsible for ischemic events. The two phases can occur successively or together. The Ishikawa criteria proposed in 1988 are too restrictive because they exclude patients older than 40 at the time of disease onset and patients with an involvement of the abdominal aorta and iliac arteries (occurring in 11% to 30% of cases). Despite improvements to these criteria, the American College of Rheumatology’s criteria for Takayasu’s disease are still questionable. Takayasu’s disease can be confused with other stenotic diseases of the subclavian artery, and arteriography is the only recommended reference method for diagnosis. A duplex ultrasound examination, a noninvasive, highly sensitive, and specific examination for the vascular lesions of the supra-aortic trunk and abdominal aorta, can help establish the diagnosis of Takayasu’s disease. The advantage of an ultrasound examination is that the circumferential thickening observed in the systemic inflammatory state is often undetected by angiography. This presentation advocated for the systematic use of duplex ultrasound investigation to identify inflammatory thickening of the vessel wall, especially in children and young adults.