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Peripheral Angio.

Guidelines

NICE Peripheral Arterial Disease. CG147 2012, 2020 1

1.3 Diagnosis

Assessment includes: 1) Ask about presence & severity of possible symptoms of intermittent claudication and critical limb ischaemia.
2) Examine legs for signs of critical limb ischaemia, ie arterial ulceration.
3) Examine Femoral , Popliteal & foot pulses. 4) Measure Ankle Brachial Pressure Index (ABPI). Can be falsely normal in DM. $$ ABPI = Highest Ankle Pressure / Highest Arm Pressure. $$

1.4 Imaging for Revascularization

1.4.1

Offer duplex ultrasound as first‑line imaging to all people with peripheral arterial disease for whom revascularisation is being considered.

1.4.2

Offer contrast‑enhanced magnetic resonance angiography to people with peripheral arterial disease who need further imaging (after duplex ultrasound) before considering revascularisation. [2012]

1.4.3

Offer computed tomography angiography to people with peripheral arterial disease who need further imaging (after duplex ultrasound) if contrast‑enhanced magnetic resonance angiography is contraindicated or not tolerated. [2012]

1.5 Management of Intermittent Claudication

Essentially is a Supervised Exercise programme and modification of risk factors for 3 months.
Angioplasty is only done if this has failed and a MRA/CTA at this time shows a suitable lesion.

1.6 Management of Critical Limb Ischaemia

Needs an MDM decision.
Plan for revascularisation or amputation.

  1. https://www.nice.org.uk/guidance/cg147/chapter/Recommendations#diagnosis ↩