Increasing Guideline-Directed Care Adherence in Peripheral Artery Disease

A recent study has indicated the suboptimal adherence to guideline-directed care (GDC) among patients with peripheral artery disease (PAD) who receive surgical interventions.¹

Presented at the 2026 Vascular Annual Meeting (VAM26) in Boston, Massachusetts, by Richard Shi, MD, a vascular surgery resident at the Medical University of South Carolina, and Adam Tanious, MD, MBA, associate professor within the Division of Vascular Surgery at the Medical University of South Carolina, these data highlight the larger issue of insufficient care among claudicants, potentially resulting in worse long-term outcomes following intervention.¹

“Real life in patient care always happens,” Tanious told HCPLive in an exclusive interview. “You’ve got 3 other patients waiting in clinic, and you get to your documentation at the end of the day. You were going to write the prescription for the pletal or for the aspirin, but it didn’t go through – real life always happens. We’re trying to obviate that by creating a pathway for it.”

The study itself was a retrospective analysis including claudicants with endovascular or open intervention between 2014 and 2023. GDC was defined as severe lifestyle limitation documentation, optimal medical therapy adherence, and exercise therapy completion. Partial adherence involved only medical therapy adherence, while non-adherence was a lack thereof. The primary endpoint was 2-year major adverse limb events (MALEs), which were a composite of major amputation or major open/endovascular reintervention of the target limb.¹

A total of 258 patients were included – of these, 43% demonstrated non-adherence. Another 44.2% demonstrated partial adherence, while 12.8% demonstrated complete GDC adherence. MALE was recorded in 23.3% of claudicants at 2 years, largely due to reintervention. Kaplan-Meier analysis indicated a higher MALE-free survival rate among patients with complete adherence (87.9%) versus partial adherence (78.1%) and nonadherence (72.1%).¹

Tanious and Shi highlighted the 12.8% of enrolled patients who had a record of completed GDC, leaving over ¾ of all patients with incomplete care prior to intervention. To combat this, the team is currently developing and testing a clinical pathway based on electronic health records to optimize claudicants’ access to GDC. An ongoing prospective study at the Medical University of South Carolina has enrolled >100 patients – Tanious and Shi plan to present these data at an as-yet-unspecified society meeting.²

Tanious and Shi also discussed their hopes for the study’s impact on PAD care, particularly in terms of guiding as many patients as possible to receive and complete GDC prior to surgery. In addition to optimizing immediate treatment outcomes, the study reflects that GDC can prevent MALEs after intervention as well, mitigating long-term risk and avoiding complications.¹

“Our hope is that this paper encourages every vascular surgeon to think of the 3 boxes of guideline-directed care, and every time they see a claudicant, they should have a template in their notes for these patients so that they answer these 3 questions every time,” Tanious said. “How much is this disease affecting the way you live? Are you on all the optimal medical therapy we can offer? Have you tried doing some form of exercise therapy? And until all of these 3 are yes, you should try as hard as possible to refrain from intervening.”

Editors’ Note: Shi and Tanious report no relevant disclosures.

References

1. Shi R, Tanious A, Bulatao N. Comparing Major Adverse Limb Events in Claudicants with Complete, Partial, and Non-Adherence to Pre-Operative Guideline-Directed Care. Presented at the 2026 Vascular Annual Meeting, Boston, MA. June 10-13, 2026.

2. Grassley B. Complete Adherence to Guideline-Directed Care Associated with Decreased Serious Limb Complications at Two Years. Society for Vascular Surgery. June 10, 2026. Accessed July 8, 2026. https://vascular.org/news-advocacy/articles-press-releases/complete-adherence-guideline-directed-care-associated