Lights and shadows of guidelines on peripheral arterial disease

: Guidelines have become increasingly important in the choice of the best treatment for each disease. At present, they should be regarded as recommendations drawn from a multidisciplinary and shared interpretation of available scientific information to assist physicians and patients in deciding the most appropriate program of care for a specific clinical condition. Since many years, the TransAtlantic Inter-Society Consensus (TASC) guidelines have represented the reference guidelines for peripheral arterial disease, widely accepted by the scientific community. A continuous update of guidelines should be advisable, at least on a 2-year basis, in order to include new evidence derived from clinical research and practice. In particular, endovascular treatment should be considered the first-line therapeutic option for all patients with peripheral arterial disease, different from what suggested by current guidelines. The results obtained at our Division of Vascular Surgery support this indication, showing a low complication rate and reserving surgery only to selected cases or hybrid procedures.