Chart 10.3.

Risk Factors / Therapeutic Conduct and their Recommendation Classes / Levels of Evidence at DAPEI according to the latest international Peripheral Artery Disease guidelines

Risk Factor / Therapeutic Management	Society for Vascular Medicine Guidelines (2015)484	AHA / ACC Guidelines (2016)483	European Society of Cardiology (ESC) Guidelines (2018)482
Smoking	Comprehensive preventive interventions aimed at smoking cessation in asymptomatic Lower extremity PAD, intermittent claudication and after open endovascular or surgical procedure I-A	Lower extremity PAD smoking cessation programs, including pharmacotherapy I-A	Smoking cessation is recommended in all patients with Lower extremity PAD I-B
Statins	In Lower extremity PAD  with intermittent claudication I-A Optimized statin therapy is recommended for all patients with claudication and after endovascular or open surgical procedure I-A	Suitable for all patients with Lower extremity PAD I-A	Recommended statins for all patients with Lower extremity PAD I-A In patients with Lower extremity PAD it is recommended to lower LDL-c below 70 mg/dL or to decrease it by > 50% if baseline values are between 70-135 mg/dL I-C
Physical exercise	Supervised Exercises I-A Residential exercises I-B Post limb revascularization exercises for claudication I-B At least annual follow-up of claudication to check the results from exercise I-C	Treadmill test may help in functional evaluation in Lower extremity PAD IIa-B Supervised exercises in patients with claudication I-A Residential or community exercises with behavioral change techniques may be beneficial in functional improvement IIa-A In lameness patients, alternative exercises such as low intensity, painless walking may be beneficial in functional improvement IIa-A	Supervised exercises are recommended in patients with lameness. I-A Unsupervised exercise in patients with claudication I-C Healthy diet and physical activity are recommended in patients with Lower extremity PAD I-C
Antiplatelets	Use of aspirin 75-325 mg/day in claudication I-A In claudication, use of clopidogrel (75 mg/day) as an effective alternative to aspirin IIb Optimized antiplatelet therapy is recommended for all patients with claudication and after endovascular or open surgical procedure I-A Improves patency of venous and artificial lower limb vascular grafts II-B In infrainguinal endovascular intervention for lower limb claudication, aspirin with clopidogrel for at least 30 days is suggested IIb	Use of aspirin monotherapy (75-325 mg/day) or clopidogrel monotherapy in claudication (75 mg/day) reduces AMI, stroke and vascular death I-A In asymptomatic Lower extremity PAD, antiplatelet use is reasonable to prevent risk of AMI, stroke and vascular death IIa-C In asymptomatic borderline ABI Lower extremity PAD, the advantage of antiplatelets is uncertain to prevent risk of AMI, stroke and vascular death IIb-B The efficacy of dual antiplatelet therapy (aspirin + clopidogrel) in reducing risk of CV events in symptomatic Lower extremity PAD is not well established IIb-B Dual antiplatelet therapy (aspirin + clopidogrel) may be reasonable to reduce risk of lower limb events in symptomatic Lower extremity PAD following limb revascularization IIb-C	In patients with symptomatic Lower extremity PAD, antiplatelet monotherapy is indicated I-A In all patients with revascularized Lower extremity PAD, antiplatelet monotherapy is indicated I-C In infrared revascularized Lower extremity PAD, antiplatelet monotherapy is indicated I-A In patients with Lower extremity PAD requiring antiplatelet agents, clopidogrel may be preferable to aspirin IIb-B Following infrainguinal endovascular intervention with stenting for lower limb claudication, aspirin + clopidogrel for at least 30 days is suggested IIa-C After prosthetic bypass graft in infrapopliteal PAD (below the knee), the use of aspirin + clopidogrel IIb-B
Anticoagulants	They reduce the risk of limb loss and increase graft patency, but double the risk of bleeding compared with antiplatelet agents B-C Suggests against warfarin use only to reduce risk of CV events or vascular occlusions I-C	The usefulness of oral anticoagulants in maintaining patency of vascular grafts is uncertain IIb-B Anticoagulation should not be used to reduce risk of CV events in Lower extremity PAD III-A	Vitamin K antagonist may be considered after revascularization with infra-inguinal autologous venous graft. IIb-B
Antihypertensives	Optimized antihypertensive therapy is recommended for all patients with claudication and after endovascular or open surgical procedure I-A	Antihypertensive therapy recommended in hypertensive patients to reduce the risk of AMI, stroke, heart failure and CV death inLower extremity PAD I-A Use of ACE inhibitors or ARB may be effective in reducing risk of CV events in Lower extremity PAD IIa	In hypertensive patients with Lower extremity PAD it is recommended to maintain BP < 140/90 mmHg I-A The use of ACE inhibitors or ARB is considered a drug of choice in patients with Lower extremity PAD and hypertension IIa-B
Diabetes, glycemic control and hypoglycemic drugs	Hemoglobin A1C target < 7.0% in lameness if it can be achieved without hypoglycaemia I-B Recommended optimized glycemic control for all patients with claudication and after endovascular or open surgical procedure I-A	Optimized glycemic control may be beneficial in patients with critical lower extremity ischemia to reduce limb outcomes IIa-B	Strict glycemic control in diabetic patients with Lower extremity PAD I-C

ABI*: Ankle-Brachial Index; ACEI: angiotensin-converting enzyme inhibitors; AMI: acute myocardial infarction; ARB: angiotensin receptor blocker; CV: cardiovascular; CVI: Stroke; Lower extremity PAD: lower extremity peripheral arterial disease.