Following the publication of the Inter-Society Consensus for the Management of PAD (TASC) guidelines in 2000, a number of US guidelines have been developed to guide the appropriate detection and treatment of Peripheral Artery Disease (PAD), such as those developed by the American College of Cardiology (ACC) in collaboration with the American Heart Association (AHA). However, there is a notable lack of international guidelines for the management of PAD that present a standard of disease management appropriate to all geographic regions, and that take into account expert opinion from many national and international bodies.

Not only is there considerable variation in the medical care offered to patients with PAD from country to country, but also from one hospital to another in the same country. The consensus document devised by the TASC II Working Group aims to define and establish international standards for disease management, thereby optimizing the care offered to patients with PAD, or at risk of PAD, across the globe.

It is widely recognized that a range of different health care professionals are responsible for managing patients with PAD, and that each brings different expertise. Increasingly, primary care providers are playing a pivotal role in the detection and treatment of PAD, and there is a need for a set of guidelines that reflects this shift and addresses the educational needs that currently exist within primary care.

In the field of PAD, as in other areas of medical research, our understanding of disease pathogenesis and appropriate disease management is rapidly evolving. There is therefore the need to regularly update guidelines in line with new research evidence and emerging treatments, and the TASC II guidelines reflect the shift in our understanding over the past 2 years, as well as the rapidly changing pharmacologic landscape for PAD. Indeed, the TASC II guidelines also incorporate information about possible future treatment strategies.

Both the guidelines produced by TASC in 2000 and those produced by the ACC/AHA in 2005 are very long and detailed. To address this issue, the TASC II guidelines focus on the management of PAD as a result of atherosclerosis affecting the legs only. Furthermore, they focus on the key aspects of diagnosis and management and are, therefore, much easier to use, facilitating widespread distribution and dissemination of the guideline recommendations.

There is a large body of evidence suggesting that atherosclerotic risk factors are underdetected and undertreated in patients with PAD. Recognition and treatment of hyperlipidemia and hypertension in PAD patients is suboptimal, glycemic control in patients with concurrent diabetes is rarely achieved and antiplatelet therapy is underutilized. Furthermore, despite the proven efficacy of regular exercise in PAD patients, many patients remain sedentary and overweight/obese. In order to address the suboptimal management of risk factors, there is a need for both increased awareness of PAD and its risk.

In this section the full-text guidelines are available for download. Summaries of the guidelines sections are available (updated reguarly), as well as an explanation of the grading system.

Citations for TASC II:

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33 (Suppl 1): S1-75. PMID 17140820.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 (Suppl S): S5-67. PMID 17223489.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease. Int Angiol 2007; 26 (2): 81-157. PMID 17489079.