Chinese expert consensus on management of peripheral arterial disease in the elderly_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHAO Jichun ¹ ,  GUO Pingfan ² ,  HUANG Jianhua ³ ,  ZHAO Yu ⁴ ,  ZHANG Long ⁵ ,  ZHANG Lan ⁶ ,  LI Yongjun ⁷ , Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society

1. West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, P. R. China;
3. Xiangya Hospital of Central South University, Changsha 410028, P. R. China;
4. The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;
5. Peking University Third Hospital, Beijing 100191, P. R. China;
6. Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P. R. China;
7. Beijing Hospital, Beijing 100730, P. R. China;

Corresponding?author：

ZHAO Jichun, Email: zhaojc3@126.com; GUO Pingfan, Email: fjxgguo@126.com; HUANG Jianhua, Email: 13507319258@139.com; ZHAO Yu, Email: 820994765@qq.com; ZHANG Long, Email: longzh2000@163.com; ZHANG Lan, Email: lucky200207@aliyun.com; LI Yongjun, Email: liyongjun4679@bjhmoh.cn

Keywords：

arteriosclerosis obliterans; peripheral artery disease; elderly; consensus

DOI：

10.7507/1007-9424.202512123

Video：

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Abstract Full text Figures/Tables Video References Cited by

Lower extremity arteriosclerosis obliterans, also known as peripheral artery disease (PAD), is a chronic arterial occlusive disease characterized by atherosclerosis affecting the arteries of the lower extremities, leading to luminal stenosis or occlusion, and consequently resulting in ischemia and necrosis of the lower limbs. PAD not only significantly reduces patients’ quality of life but also carries a non-negligible risk of amputation and mortality, imposing a heavy economic and health burden on both patients and society, especially among the elderly. Advanced age has been identified in multiple studies as a key risk factor for amputation and death in PAD patients. The prevalence of PAD in the elderly increases significantly with age, who often have multiple coexisting conditions such as coronary artery disease, renal insufficiency, and tumors. Consequently, the pathophysiological characteristics, treatment options, and prognostic assessments are more complex compared to younger patients. Diagnostically, because the symptoms of PAD in elderly patients can often be masked by comorbidities, a comprehensive approach involving detailed medical history, physical examination, and auxiliary tests are required. In terms of treatment, the management of elderly patients with PAD is further complicated by issues such as poor adherence to therapy and difficulties in follow-up, which increase the challenges in clinical management. Currently, there is a lack of specific national or international guidelines or consensuses focused on the diagnosis and treatment of PAD in the elderly. To address this gap, the “Chinese expert consensus on management of peripheral arterial disease in the elderly” has been developed. This consensus integrates the latest evidence-based medical data and clinical experience, with a focus on key issues in elderly PAD patients, such as disease characteristics, comorbidity management, personalized treatment, and long-term follow-up. It aims to establish scientific and practical diagnostic and therapeutic standards to provide guidance for clinicians.

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2.	Song P, Rudan D, Wang M, et al. National and subnational estimation of the prevalence of peripheral artery disease (PAD) in China: a systematic review and meta-analysis. J Glob Health, 2019, 9(1): 010601. doi: 10.7189/jogh.09.010601.
3.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
4.	Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res, 2021, 128(12): 1818-1832.
5.	Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2024, 149(24): e1313-e1410. doi: 10.1161/CIR.0000000000001251.
6.	Gornik HL, Aronow HD, Goodney PP, et al. Correction to: 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2025, 151(14): e918. doi: 10.1161/CIR.0000000000001329.
7.	Diehm C, Allenberg JR, Pittrow D, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation, 2009, 120(21): 2053-2061.
8.	Gao L, Zhao W, Liu Q, et al. Association between metabolic syndrome and peripheral arterial disease in elderly patients with type 2 diabetes. Diabetes Metab Syndr Obes, 2021, 14: 4783-4789.
9.	Fontaine R, Kim M, Kieny R. Surgical treatment of peripheral circulation disorders. Helv Chir Acta, 1954, 21(5-6): 499-533.
10.	Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg, 1997, 26(3): 517-538.
11.	Mills JL Sr, Conte MS, Armstrong DG, et al. The Society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg, 2014, 59(1): 220-34. e1-2. doi: 10.1016/j.jvs.2013.08.003.
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18.	Takeji Y, Yamaji K, Tomoi Y, et al. Impact of frailty on clinical outcomes in patients with critical limb ischemia. Circ Cardiovasc Interv, 2018, 11(7): e006778. doi: 10.1161/CIRCINTERVENTIONS.118.006778.
19.	Addison O, Prior SJ, Kundi R, et al. Sarcopenia in peripheral arterial disease: prevalence and effect on functional status. Arch Phys Med Rehabil, 2018, 99(4): 623-628.
20.	Yokoyama M, Watanabe T, Otaki Y, et al. Impact of objective malnutrition status on the clinical outcomes in patients with peripheral artery disease following endovascular therapy. Circ J, 2018, 82(3): 847-856.
21.	Klaphake S, de Leur K, Mulder PG, et al. Mortality after major amputation in elderly patients with critical limb ischemia. Clin Interv Aging, 2017, 12: 1985-1992.
22.	Boyle JR, Atkins ER, Birmpili P, et al. A best practice clinical care pathway for peripheral arterial disease. J Vasc Soc G B Irel, 2022, 1(Supp3): S1-S13. doi: org/10.54522/jvsgbi.2022.017. doi: 10.54522/jvsgbi.2022.017.
23.	Fagard K, Deschodt M, Geyskens L, et al. Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals. Eur Geriatr Med, 2023, 14(2): 239-249.
24.	中國老年學和老年醫學學會. 老年冠心病慢病管理指南. 中西醫結合研究, 2023, 15(1): 30-42.
25.	Nordanstig J, Behrendt CA, Baumgartner I, et al. Editor’s choice— European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of asymptomatic lower limb peripheral arterial disease and intermittent claudication. Eur J Vasc Endovasc Surg, 2024, 67(1): 9-96.
26.	施紅, 趙燁婧, 鄧琳子. 老年綜合評估的臨床意義與應用進展. 中國心血管雜志, 2021, 26(5): 413-417.
27.	中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會. 抗血小板治療中國專家共識. 中華心血管病雜志, 2013, 41(3): 183-194.
28.	Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med, 2017, 377(14): 1319-1330.
29.	中國血脂管理指南修訂聯合專家委員會. 中國血脂管理指南(2023年). 中國循環雜志, 2023, 38(3): 237-271.
30.	中國成人血脂異常防治指南修訂聯合委員會. 中國成人血脂異常防治指南(2016年修訂版). 中華全科醫師雜志, 2017, 16(1): 15-35.
31.	Rodríguez-Valiente M, Fuente-Mora C, Sánchez-Gálvez J, et al. Cellular therapy for the peripheral arterial disease treatment: protocol for a systematic review and meta-analysis. PLoS One, 2025, 20(1): e0314070. doi: 10.1371/journal.pone.0314070.
32.	Writing Committee Members, Gornik HL, Aronow HD, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol, 2024, 83(24): 2497-2604.
33.	Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
34.	Tan YQ, Chen HW, Li J. Astragaloside Ⅳ: an effective drug for the treatment of cardiovascular diseases. Drug Des Devel Ther, 2020, 14: 3731-3746.
35.	Jo HG, Baek E, Lee D. Comparative efficacy of East Asian herbal formulae containing Astragali Radix-Cinnamomi Ramulus herb-pair against diabetic peripheral neuropathy and mechanism prediction: a Bayesian network meta-analysis integrated with network pharmacology. Pharmaceutics, 2023, 15(5): 1361. doi: 10.3390/pharmaceutics15051361.
36.	康永, 李嬋, 劉桂芳, 等. 顧步湯聯合復方黃柏液對糖尿病足干性壞疽介入術后創面改善的影響. 南京中醫藥大學學報, 2023, 39(2): 124-130.
37.	張萍, 張誼, 王本志, 等. 中藥制劑治療老年慢性創面中的臨床應用//2018中國老年醫學和老年健康產業大會(CCGI)論文集. 濟南: 中國健康促進基金會, 2018: 67.
38.	《拔毒生肌散臨床應用專家共識》項目組. 拔毒生肌散臨床應用專家共識. 世界中醫藥, 2023, 18(10): 1357-1361.
39.	Huang YY, Lin CW, Cheng NC, et al. Effect of a novel macrophage-regulating drug on wound healing in patients with diabetic foot ulcers: a randomized clinical trial. JAMA Netw Open, 2021, 4(9): e2122607. doi: 10.1001/jamanetworkopen.2021.22607.
40.	孫寧, 王銘瞳, 王卉, 等健康管理對老年男性動脈粥樣硬化的影響. 中華健康管理學雜志, 2009, 3(5): 295-298.
41.	朱夢春. 下肢動脈硬化閉塞癥患者自我管理能力量表的編制及現狀調查. 南昌: 南昌大學醫學部, 2020.
42.	張晶, 秦悅, 王紅偉, 等電話隨訪對老年下肢動脈硬化閉塞癥患者行介入治療術后服藥依從性和療效的影響. 中國老年學雜志, 2017, 37(11): 2786-2787.
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1. 趙渝, 趙紀春, 張嵐, 等. 老年人慢性靜脈疾病診治中國專家共識. 中國普外基礎與臨床雜志, 2025, 32(4): 397-409.
2. Song P, Rudan D, Wang M, et al. National and subnational estimation of the prevalence of peripheral artery disease (PAD) in China: a systematic review and meta-analysis. J Glob Health, 2019, 9(1): 010601. doi: 10.7189/jogh.09.010601.
3. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
4. Aday AW, Matsushita K. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res, 2021, 128(12): 1818-1832.
5. Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2024, 149(24): e1313-e1410. doi: 10.1161/CIR.0000000000001251.
6. Gornik HL, Aronow HD, Goodney PP, et al. Correction to: 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2025, 151(14): e918. doi: 10.1161/CIR.0000000000001329.
7. Diehm C, Allenberg JR, Pittrow D, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation, 2009, 120(21): 2053-2061.
8. Gao L, Zhao W, Liu Q, et al. Association between metabolic syndrome and peripheral arterial disease in elderly patients with type 2 diabetes. Diabetes Metab Syndr Obes, 2021, 14: 4783-4789.
9. Fontaine R, Kim M, Kieny R. Surgical treatment of peripheral circulation disorders. Helv Chir Acta, 1954, 21(5-6): 499-533.
10. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg, 1997, 26(3): 517-538.
11. Mills JL Sr, Conte MS, Armstrong DG, et al. The Society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg, 2014, 59(1): 220-34. e1-2. doi: 10.1016/j.jvs.2013.08.003.
12. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASCⅡ). J Vasc Surg, 2007, 45 Suppl S: S5-S67. doi: 10.1016/j.jvs.2006.12.037.
13. 中國醫療保健國際交流促進會難治性高血壓與周圍動脈病分會專家共識起草組. 同步四肢血壓和臂踝脈搏波速度測量臨床應用中國專家共識. 中國循環雜志, 2020, 35(6): 521-528.
14. 國家心血管病專家委員會血管外科專業委員會下肢動脈疾病學組, 中國醫藥教育協會血管外科專業委員會. 股腘動脈閉塞癥的診斷和治療中國專家共識. 中國循環雜志, 2022, 37(7): 669-676.
15. Matsushita K, Ballew SH, Sang Y, et al. Ankle-brachial index and physical function in older individuals: the Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis, 2017, 257: 208-215.
16. Schwartz JB, Schmader KE, Hanlon JT, et al. Pharmacotherapy in older adults with cardiovascular disease: report from an American College of Cardiology, American Geriatrics Society, and National Institute on Aging Workshop. J Am Geriatr Soc, 2019, 67(2): 371-380.
17. Zhang Y, Zhao W, Chen Z, et al. The correlation between muscle loss and the severity of vascular stenosis in elderly patients with peripheral artery disease: a retrospective analysis utilizing computed tomography. Aging Clin Exp Res, 2025, 37(1): 78. doi: 10.1007/s40520-025-02996-8.
18. Takeji Y, Yamaji K, Tomoi Y, et al. Impact of frailty on clinical outcomes in patients with critical limb ischemia. Circ Cardiovasc Interv, 2018, 11(7): e006778. doi: 10.1161/CIRCINTERVENTIONS.118.006778.
19. Addison O, Prior SJ, Kundi R, et al. Sarcopenia in peripheral arterial disease: prevalence and effect on functional status. Arch Phys Med Rehabil, 2018, 99(4): 623-628.
20. Yokoyama M, Watanabe T, Otaki Y, et al. Impact of objective malnutrition status on the clinical outcomes in patients with peripheral artery disease following endovascular therapy. Circ J, 2018, 82(3): 847-856.
21. Klaphake S, de Leur K, Mulder PG, et al. Mortality after major amputation in elderly patients with critical limb ischemia. Clin Interv Aging, 2017, 12: 1985-1992.
22. Boyle JR, Atkins ER, Birmpili P, et al. A best practice clinical care pathway for peripheral arterial disease. J Vasc Soc G B Irel, 2022, 1(Supp3): S1-S13. doi: org/10.54522/jvsgbi.2022.017. doi: 10.54522/jvsgbi.2022.017.
23. Fagard K, Deschodt M, Geyskens L, et al. Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals. Eur Geriatr Med, 2023, 14(2): 239-249.
24. 中國老年學和老年醫學學會. 老年冠心病慢病管理指南. 中西醫結合研究, 2023, 15(1): 30-42.
25. Nordanstig J, Behrendt CA, Baumgartner I, et al. Editor’s choice— European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of asymptomatic lower limb peripheral arterial disease and intermittent claudication. Eur J Vasc Endovasc Surg, 2024, 67(1): 9-96.
26. 施紅, 趙燁婧, 鄧琳子. 老年綜合評估的臨床意義與應用進展. 中國心血管雜志, 2021, 26(5): 413-417.
27. 中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會. 抗血小板治療中國專家共識. 中華心血管病雜志, 2013, 41(3): 183-194.
28. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med, 2017, 377(14): 1319-1330.
29. 中國血脂管理指南修訂聯合專家委員會. 中國血脂管理指南(2023年). 中國循環雜志, 2023, 38(3): 237-271.
30. 中國成人血脂異常防治指南修訂聯合委員會. 中國成人血脂異常防治指南(2016年修訂版). 中華全科醫師雜志, 2017, 16(1): 15-35.
31. Rodríguez-Valiente M, Fuente-Mora C, Sánchez-Gálvez J, et al. Cellular therapy for the peripheral arterial disease treatment: protocol for a systematic review and meta-analysis. PLoS One, 2025, 20(1): e0314070. doi: 10.1371/journal.pone.0314070.
32. Writing Committee Members, Gornik HL, Aronow HD, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol, 2024, 83(24): 2497-2604.
33. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J, 2024, 45(36): 3538-3700.
34. Tan YQ, Chen HW, Li J. Astragaloside Ⅳ: an effective drug for the treatment of cardiovascular diseases. Drug Des Devel Ther, 2020, 14: 3731-3746.
35. Jo HG, Baek E, Lee D. Comparative efficacy of East Asian herbal formulae containing Astragali Radix-Cinnamomi Ramulus herb-pair against diabetic peripheral neuropathy and mechanism prediction: a Bayesian network meta-analysis integrated with network pharmacology. Pharmaceutics, 2023, 15(5): 1361. doi: 10.3390/pharmaceutics15051361.
36. 康永, 李嬋, 劉桂芳, 等. 顧步湯聯合復方黃柏液對糖尿病足干性壞疽介入術后創面改善的影響. 南京中醫藥大學學報, 2023, 39(2): 124-130.
37. 張萍, 張誼, 王本志, 等. 中藥制劑治療老年慢性創面中的臨床應用//2018中國老年醫學和老年健康產業大會(CCGI)論文集. 濟南: 中國健康促進基金會, 2018: 67.
38. 《拔毒生肌散臨床應用專家共識》項目組. 拔毒生肌散臨床應用專家共識. 世界中醫藥, 2023, 18(10): 1357-1361.
39. Huang YY, Lin CW, Cheng NC, et al. Effect of a novel macrophage-regulating drug on wound healing in patients with diabetic foot ulcers: a randomized clinical trial. JAMA Netw Open, 2021, 4(9): e2122607. doi: 10.1001/jamanetworkopen.2021.22607.
40. 孫寧, 王銘瞳, 王卉, 等健康管理對老年男性動脈粥樣硬化的影響. 中華健康管理學雜志, 2009, 3(5): 295-298.
41. 朱夢春. 下肢動脈硬化閉塞癥患者自我管理能力量表的編制及現狀調查. 南昌: 南昌大學醫學部, 2020.
42. 張晶, 秦悅, 王紅偉, 等電話隨訪對老年下肢動脈硬化閉塞癥患者行介入治療術后服藥依從性和療效的影響. 中國老年學雜志, 2017, 37(11): 2786-2787.
43. Koelemay MJW, van Reijen NS, van Dieren S, et al. Editor’s choice—randomised clinical trial of supervised exercise therapy vs. endovascular revascularisation for intermittent claudication caused by iliac artery obstruction: the SUPER study. Eur J Vasc Endovasc Surg, 2022, 63(3): 421-429.
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