The following are key points to remember from the 2024 European Society of Cardiology (ESC) guidelines for the management of peripheral arterial and aortic diseases:

1. The new guidelines update and merge the 2017 peripheral arterial diseases (PAD) and 2014 aortic diseases guidelines. Key revised recommendations are listed below.
2. Screening for abdominal aortic aneurysms (AAA) with a duplex ultrasound in men age ≥65 years who have a history of smoking, in all men age ≥75 years (regardless of smoking status), and in women age ≥75 years if active smoker and/or hypertensive. Previously, screening in women was restricted to current/former smokers age >65 years and was contraindicated for nonsmoking women.
3. First-degree relatives age ≥50 years of patients with AAA should be screened with duplex ultrasound unless another cause for the index AAA can be clearly identified. This is now a Class I recommendation (previously was Class IIa).
4. In patients with PAD and hypertension, the goal systolic blood pressure is 120-129 mm Hg. Previously, the recommendation was <140/90 mm Hg.
5. In patients with atherosclerotic PAD, the ultimate low-density lipoprotein cholesterol (LDL-C) reduction goal is now <55 mg/dL and a >50% reduction from baseline (Class I, Level A). The previous goal was <70 mg/dL.
6. In patients with acute mesenteric ischemia due to acute occlusion of the superior mesenteric artery, endovascular revascularization is recommended over open surgery (Class I, Level B). Previously, either surgical technique was recommended.
7. In patients with ascending aortic aneurysms, surgery is recommended at a maximal diameter of ≥55 mm Hg (now Class I, Level B). A valve sparing aortic root replacement is recommended in experienced centers (Class I, Level B).
8. After open repair of an AAA, the first follow-up imaging is recommended within 1 year postoperative and every 5 years thereafter (now Class I, Level A). After endovascular repair of the aorta, the first follow-up computed tomography (CT) is recommended at 1 month and a duplex ultrasound at 12 months and every year thereafter (Class I, Level A).
9. In patients with a complicated type B intramural hematoma, thoracic endovascular aortic repair is now recommended as a Class I intervention. The same is true for a type A penetrating atherosclerotic ulcer (surgery) and complicated type B penetrating atherosclerotic ulcer (endovascular treatment).
10. CT or magnetic resonance imaging (MRI) of the thoracic aorta initially, with discrepancy between CT/MRI and echocardiogram, and when the aortic diameter exceeds 45 mm (Class I, Level C). Surveillance with serial echocardiogram is recommended in any patients with a bicuspid aortic valve >40 mm after 1 year and every 2-3 years (Class I, Level C).
11. Surgery for bicuspid aortic valve and ascending aortic aneurysm should be considered at a diameter ≥45 mm (Class IIa, Level C).

Clinical Topics: Vascular Medicine, Atherosclerotic Disease (CAD/PAD)

Keywords: Aortic Diseases, Peripheral Arterial Disease, ESC Congress, ESC24

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