14 August 2012

Call for Better Diagnosis of Peripheral Arterial Disease

GPs should make an early diagnosis of peripheral arterial disease (PAD) by performing an ankle brachial pressure index measurement, as NICE sets out new guidelines on the diagnosis and management of lower limb PAD.

Peripheral arterial disease is a common condition, affecting 3- 7 per cent of people in the general population and 20 per cent of people over the age of 60, in which the arteries carrying blood to the legs and feet become narrowed or blocked.

Despite the relatively high incidence of PAD, recognition and treatment of the disease varies across England.

The latest recommendations aim to resolve the considerable uncertainty and variations in practice and improve outcomes for patients.

NICE recommends assessing people with suspected PAD by asking about the presence and severity of possible symptoms of intermittent claudication and critical limb ischaemia, examining the legs and feet for evidence of critical limb ischaemia, for example ulceration, examining the femoral, popliteal and foot pulses, and measuring the ankle brachial pressure index.

All patients with PAD should be given information, advice, support and treatment regarding the secondary prevention of cardiovascular disease, in line with published NICE guidance.

Other recommendations include offering supervised exercise programme to all patients with intermittent claudication, and ensuring that all people with critical limb ischaemia are assessed by a vascular multi-disciplinary team before treatment decisions are made.

Dr Anita Sharma, GP Principal, Clinical Director Vascular and Elective Care Clinical Commissioning Group, Oldham and member of the Guideline Development Group, said: “Patients with peripheral arterial disease are under diagnosed and undertreated despite the fact that it is associated with an increased risk of cardiovascular mortality.

“Patients with asymptomatic peripheral arterial disease are just as likely to progress to critical ischaemia as those with symptoms.

“An early diagnosis by doing ankle brachial pressure index measurement, introducing risk reduction strategies and maximising secondary prevention can slow down the progression of the condition and this can be easily done in primary care. For me as a GP peripheral arterial disease management means Prevent an Amputation and Death due to cardiovascular event.”

Jonathan Michaels, Professor of Clinical Decision Science, University of Sheffield, and Chair of the Guideline Development Group, said: “This guideline provides clear recommendations on reducing the risk of future circulatory problems, and on accurate diagnosis and treatment of the disease in the legs.

“The importance of lifestyle changes is emphasised, particularly the benefit of exercise and supervised exercise programmes. For those requiring further treatments for their leg symptoms the recommendations cover modern diagnostic methods, surgery and less invasive treatments, which should be available from multi-disciplinary teams able to offer a full range of specialist treatments.”

A suite of support tools are available for this guidance including a costing report and template, clinical audit tools, and a baseline assessment tool.