Healthcare guidance body NICE has published draft recommendations on the diagnosis and management of lower limb peripheral arterial disease (PAD).
The draft guideline highlights a number of important changes that are needed in order to resolve the considerable uncertainty and variations in practice that currently exist in this area and improve outcomes for patients. Treatment options depend on the level of severity and may include: changes in lifestyle (for example, smoking cessation, advice to exercise, and management of cardiovascular risk factors by taking aspirin and statins); vasoactive drug treatment such as naftidrofuryl; endovascular treatments – including balloon angioplasty, endovascular stents and a range of new adjunct or alternative treatments; and surgical reconstruction to unblock or bypass occluded or narrowed arteries. NICE recommends that patients should be offered information, advice and support on: smoking cessation; diet, weight management and exercise; lipid modification and statin therapy; prevention, diagnosis and management of diabetes and high blood pressure; as well as drug therapy with antiplatelet agents. In addition, clinicians should assess people with suspected PAD by using structured questioning about the symptoms of intermittent claudication and critical limb ischaemia – as well as examining the femoral, popliteal and foot pulses, and measuring the ankle brachial pressure index. They should also offer contrast-enhanced magnetic resonance angiography for people with PAD, who need further imaging prior to considering an intervention; a supervised exercise programme to all people with intermittent claudication and ensure that all people with critical limb ischaemia are reviewed by a vascular multi-disciplinary team before treatment decisions are made. Patients with critical limb ischaemia should not be offered major amputation unless all options for revascularisation have been considered by a vascular multi-disciplinary team.
