Clinical Review

Diagnosis and management of peripheral arterial disease

BMJ 2012; 345 doi: (Published 14 August 2012) Cite this as: BMJ 2012;345:e5208
  1. G Peach, specialist registrar in vascular surgery,
  2. M Griffin, academic foundation year 2 trainee,
  3. K G Jones, consultant vascular surgeon,
  4. M M Thompson, professor of vascular surgery,
  5. R J Hinchliffe, Higher Education Funding Council for England clinical senior lecturer and consultant vascular surgeon
  1. 1St George’s Vascular Institute, St George’s Healthcare NHS Trust, London SW17 0QT, UK
  1. Correspondence to: R J Hinchliffe rhinchli{at}
  • Accepted 26 July 2012

Summary points

  • Peripheral artery disease (PAD) is an important marker of overall cardiovascular disease

  • All patients with PAD should receive aggressive modification of cardiovascular risk factors

  • Most patients with intermittent claudication can be managed without revascularisation (angioplasty or bypass)

  • Less than 3% of patients with intermittent claudication require major amputation within five years

  • Patients with diabetes and smokers are at particularly high risk of developing critical limb ischaemia

  • Refer all patients with rest pain, ulceration, or gangrene for specialist assessment

Peripheral arterial disease (PAD) is an atherosclerotic process that causes stenosis and occlusion of non-cerebral and non-coronary arteries. It has an estimated worldwide prevalence of almost 10%, rising to 15-20% in people over 70 years of age,1 2 and it affects around 27 million people in Europe and North America alone.3 Critical limb ischaemia—the most severe manifestation of the disease—can lead to limb loss or even death if not treated promptly. Each year, 500-1000 new cases of critical limb ischaemia are diagnosed per million of the population, with an estimated annual cost to the NHS of more than £200m (€255m; $314m).4

Sources and selection criteria

We searched Medline, Embase, and the Cochrane Database for systematic reviews and meta-analyses related to the diagnosis and management of peripheral arterial disease. We also consulted relevant national and international guidelines published by the National Institute for Health and Clinical Excellence, the Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease, and the International Working Group on the Diabetic Foot.

Increased awareness of the disease, enhanced medical treatment, and new endovascular interventions have dramatically improved the management of patients with PAD.5 6 With the publication of new National Institute for Health and Clinical Excellence (NICE) guidelines on the management of this disease, this review offers a timely summary of current evidence relating to PAD and provides …

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