Medical guidelines get updated fairly often, but most patients never hear about it until a doctor mentions something that sounds different from what they expected. In 2024, the American College of Cardiology and American Heart Association, with other multisociety partners, released the 2024 ACC/AHA guideline for lower extremity peripheral artery disease, an update to the 2016 guideline. [1] If you’re being screened, diagnosed, or treated for PAD, understanding what changed can help you make sense of decisions your care team may soon be discussing with you. The team at Vegas Vascular Specialists has been reviewing these updates closely, since they directly shape how patients across the valley are screened and treated going forward.
Overview of Updated PAD Care GuidelinesThe 2024 ACC/AHA guideline recommends resting ABI testing for people with symptoms or findings suggestive of PAD and considers it reasonable for people at increased risk. Treatment emphasizes high-intensity statins, low-dose rivaroxaban plus aspirin for appropriate patients, and structured exercise as a core therapy for claudication. For severe disease, WIfI classification guides urgency and treatment, while revascularization is considered for limb-threatening ischemia or persistent symptoms despite medication and exercise. These updates support personalized vascular care. |
Who Should Be Tested for PAD Under the 2024 Guidelines?
A resting ankle-brachial index (ABI) is recommended when symptoms or exam findings suggest PAD, and it is reasonable for people at increased risk of PAD even without symptoms. It is not recommended for people who are not at increased risk and have no signs of PAD. The guideline defines “increased risk” in detail. It includes older adults, people who smoke or have diabetes, high blood pressure or high cholesterol, and people with atherosclerotic disease in other blood vessels. Your provider can tell you whether you meet that definition. The American Heart Association’s patient guidance on PAD likewise emphasizes recognizing PAD risk factors and the possibility of disease even when symptoms are not obvious.
- A simple, painless comparison of blood pressure between the arm and ankle.
- Can be used for patients with symptoms, and considered for those at increased risk without symptoms.
- Catches narrowing early, often before any noticeable symptoms develop.
For patients in Las Vegas with these risk factors, this means a screening conversation may come up at a routine visit that wouldn’t have happened under the older approach, not because something is necessarily wrong, but because catching narrowing early gives far more treatment options later.
| Learn how PAD treatment, from structured exercise to medication and revascularization, may fit your situation. |
What Medications Are Recommended for PAD?
The 2024 guideline recommends high-intensity statin therapy for people with PAD and supports low-dose rivaroxaban (2.5 mg twice daily) plus low-dose aspirin for patients who are not at increased risk of bleeding. [2] That combination has been shown to reduce major adverse cardiovascular events and major adverse limb events.
Because bleeding risk varies from person to person, your provider will decide which medications suit you. Do not start or stop any medication without medical advice.
What Do the Guidelines Say About Exercise?
According to the American College of Cardiology, supervised exercise therapy, or a structured community-based program with behavior-change techniques, is a Class 1 recommendation for chronic symptomatic PAD, meaning the guideline strongly recommends it. [3] It applies to people with claudication, leg pain that appears during activity and eases with rest.
- Supervised sessions, often in a clinical or rehab setting.
- Structured home or community-based programs for patients who prefer or need a more flexible schedule.
- Regular reassessment to confirm the program is improving walking performance.
Structured exercise is recommended to improve walking performance, functional status, and quality of life, and it is an important part of treatment alongside medication and risk-factor management.
When Is Revascularization Recommended?
Revascularization, procedures that restore blood flow, is considered for chronic limb-threatening ischemia to help prevent limb loss, and for people whose claudication has not improved enough with medication and exercise. For chronic limb-threatening ischemia, a more advanced stage where blood flow is severely restricted, the guideline endorses the WIfI classification, which scores Wound, Ischemia, and Foot Infection to help guide treatment and urgency. The American Heart Association’s guidance on early diagnosis and treatment of PAD also emphasizes timely treatment to improve outcomes and reduce the risk of amputation. [4]
How PAD Care Recommendations Fit Together
The graphic below summarizes how the 2024 guideline’s recommendations for testing, medication, exercise, and severe disease fit together. Many of these principles build on earlier guidance, and the 2024 update refines them.
What Does a Vascular Specialist Do With These Guidelines?
Guidelines describe what is generally recommended, and applying them to one patient takes clinical judgment. Vascular medicine specialists evaluate symptoms, risk factors, test results, and bleeding risk to decide which recommendations fit each person. Vegas Vascular Specialists evaluates and manages PAD for patients in the Las Vegas area. You can review each provider’s background on our vascular specialists and provider pages.
| If you have leg symptoms, PAD risk factors, or an existing PAD diagnosis, request an evaluation to discuss your symptoms, risk factors, and testing options. |
Common Questions About the 2024 PAD Guidelines
What is an ankle-brachial index (ABI)?
An ABI is a painless test that compares blood pressure at the ankle with blood pressure at the arm to check for narrowed arteries in the legs.
Do I need PAD screening if I have no symptoms?
It depends on your risk. The guideline considers resting ABI screening reasonable for people at increased risk of PAD, and does not recommend it for people who are not at increased risk and have no signs of PAD. Your provider can tell you which applies to you.
Should every PAD patient take rivaroxaban and aspirin?
No. The combination is effective for patients with PAD who are not at increased risk of bleeding, and a provider evaluates that individually.
Do these guidelines apply to patients already being treated for PAD?
Yes. Existing treatment plans may be reviewed against updated recommendations at follow-up visits.
Is structured exercise really recommended for PAD?
Yes. For chronic symptomatic PAD, supervised or structured community-based exercise is a Class 1 recommendation to improve walking performance, function, and quality of life.
If you’re in the Las Vegas area and want to understand how the 2024 guideline applies to your own risk factors or treatment plan, request an appointment to discuss it with a vascular specialist.
References
[1] ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation. 2024;149(24):e1313–e1410. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001251
[2] American College of Cardiology. 2024 ACC/AHA/Multisociety Guideline for Lower Extremity PAD: Ten Points to Remember. May 9, 2024.
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2024/05/09/15/00/2024-guideline-for-lower-extremity-pad
[3] Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation. 2024. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001251
[4] American Heart Association. (2024, May 14). Early diagnosis & treatment of peripheral artery disease essential to improve outcomes, reduce amputation risk.
https://newsroom.heart.org/news/early-diagnosis-treatment-of-peripheral-artery-disease-essential-to-improve-outcomes-reduce-amputation-risk