BMJ 2003;326:584-588 ( 15 March )

Clinical review

Management of peripheral arterial disease in primary care

Paul Burns, research fellow ^a, Stephen Gough, reader ^b, Andrew W Bradbury, professor ^a. 

^a Department of Vascular Surgery, University of Birmingham, Birmingham B9 5SS, ^b Department of Medicine, University of Birmingham

Correspondence to A W Bradbury, University Department of Vascular Surgery, Lincoln House (Research Institute), Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS

The first 150 words of the full text of this article appear below.

Best medical treatment for peripheral arterial disease, including managing hypertension and diabetes, reduces morbidity and mortality and can obviate the need for invasive intervention

One in five of the middle aged (65-75 years) population of the United Kingdom have evidence of peripheral arterial disease on clinical examination, although only a quarter of them have symptoms. The most common symptom is muscle pain in the lower limbs on exerciseintermittent claudication.¹ Invasive interventions (angioplasty, stenting, surgery) undoubtedly have a role in the management of peripheral arterial disease. However, in common with coronary artery disease, the morbidity and mortality associated with peripheral arterial disease can be greatly reduced, and the results of intervention significantly improved, by the institution of so called "best medical treatment," much of which can be implemented in primary care.

Summary points Diagnosis of peripheral arterial disease is based mainly on the history, with examination and ankle brachial pressure index being used to confirm and localise the disease Peripheral arterial disease is a marker for systemic atherosclerosis; the risk to the limb in claudication is low, but the risk to life is high Patients with intermittent claudication should initially be treated with "best medical treatment"; some patients may be candidates for percutaneous angioplasty, but this treatment is not based on evidence Patients should be referred to a vascular surgeon if there is doubt about the diagnosis or evidence of aortoiliac disease or if the patient has not responded to best medical treatment or has severe disease

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