Practice Guidelines

Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4947 (Published 08 August 2012) Cite this as: BMJ 2012;345:e4947
  1. Jennifer Layden, senior project manager1,
  2. Jonathan Michaels, professor of clinical decision science2,
  3. Sarah Bermingham, senior health economist1,
  4. Bernard Higgins, clinical director1
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2University of Sheffield, Sheffield S10 2TN, UK
  1. Correspondence to: J Michaels j.michaels{at}sheffield.ac.uk

Lower limb peripheral arterial disease (referred to as peripheral arterial disease in this summary) is common, affecting 3% to 7% of people in the general population and 20% of people over the age of 75.1 It is associated with an increased risk of cardiovascular morbidity and mortality and severely limits people’s functional capacity and quality of life. Peripheral arterial disease is often asymptomatic, but when it is symptomatic the most common presentation is intermittent claudication (pain in the legs, buttocks, or thighs brought on by walking and relieved by rest). Critical limb ischaemia is characterised by severely diminished circulation, ischaemic pain, ulceration, tissue loss, and/or gangrene. Owing to rapid changes in diagnostic methods, endovascular treatments, and vascular services, there is considerable uncertainty about the management of people with peripheral arterial disease, with management varying greatly across England and Wales.2 This article summarises some of the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of peripheral arterial disease.3

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Secondary prevention of cardiovascular disease in people with peripheral arterial disease

  • Offer all people with peripheral arterial disease information, advice, support, and treatment with respect to the secondary prevention of cardiovascular disease, in line with published NICE guidance on smoking cessation4 5 6 7; diet, weight management, and exercise8 9 10 11; lipid modification and statin therapy12 13 14; the prevention, diagnosis, and management of diabetes15 16 17 18 19; the prevention, diagnosis, and management of high blood pressure20; and antiplatelet therapy. …

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