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Lower limb peripheral arterial disease (clinical guideline 147): a guideline summary.

Carthy ER - Ann Med Surg (Lond) (2013)

View Article: PubMed Central - PubMed

Affiliation: Imperial College London Medical School, London, UK.

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The following text summarises the National Institute for Health and Clinical Excellence (NICE) clinical guidelines (CG 147) on the diagnosis and management of lower limb peripheral arterial disease (PAD)... It addresses methods of diagnosis, information requirements, and lifestyle advice for the prevention of cardiovascular disease secondary to PAD, management of intermittent claudication and critical limb ischaemia, and the role of amputation in severe PAD... There is substantial evidence establishing the benefits of lowering cholesterol with PAD... In the Heart Protection Study, PAD patients with total cholesterol >3.5 mmol/L taking simvastatin had a 17.6% reduction in cardiovascular events compared with placebo... High blood pressure is associated with a three-fold increase in PAD and overall cardiovascular risk... Anti-hypertensive treatment, such as ACE inhibitors, have been found to have significant benefit on cardiovascular deaths... Accurate diagnosis is crucial to allow timely specialist referral and improve patient outcome, and can be diagnosed via the patient history of intermittent claudication and of symptoms of critical limb ischaemia, leg and feet examination, peripheral pulse examination, the ankle brachial pressure index (ABPI; Fig. 1; <0.9 is an indicator of PAD) and some imaging modalities not discussed in these guidelines... The NICE technology appraisal (TA 223) on “Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of IC in people with PAD” recommended naftidrofuryl oxalate as the preferred treatment... However, it is still unclear how effective this is when compared to other treatments such as exercise and angioplasty when patients are suitable for more than one option... People with critical limb ischaemia face enormous cardiovascular risk, with a 50% mortality rate within the first year of diagnosis... It is recommended than autologous veins are used whenever possible for people with critical limb ischaemia having infra-inguinal bypass surgery... However, there is no clearly established benefit when compared to prosthetic grafts... After discussing the treatment options with the patient, management of PAD should firstly focus on lifestyle interventions, before the vascular multidisciplinary team are involved who need to be crucially involved in interventional therapy, namely the need for angioplasty or bypass surgery... Prompt diagnosis of PAD is crucial in reducing the risk of complications and adverse events such as critical limb ischaemia.

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Related in: MedlinePlus

Summary of how to measure the ankle brachial pressure index (ABPI). Information obtained from NICE guidelines on peripheral arterial disease (GC 147).1
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fig0005: Summary of how to measure the ankle brachial pressure index (ABPI). Information obtained from NICE guidelines on peripheral arterial disease (GC 147).1

Mentions: Those people with symptoms suggestive of PAD, diabetes, non-healing leg or feet wounds, unexplained leg pain, those being considered for leg or foot intervention, or those using compression hosiery should be assessed for PAD. Diagnosis is initially made based on a history of leg pain on exertion, with or without additional foot and leg symptoms such as rest pain, ulcers, and tissue loss. It can also be an incidental finding in asymptomatic people attending for a general examination or diabetic foot screening. Accurate diagnosis is crucial to allow timely specialist referral and improve patient outcome, and can be diagnosed via the patient history of intermittent claudication and of symptoms of critical limb ischaemia, leg and feet examination, peripheral pulse examination, the ankle brachial pressure index (ABPI; Fig. 1; <0.9 is an indicator of PAD) and some imaging modalities not discussed in these guidelines.


Lower limb peripheral arterial disease (clinical guideline 147): a guideline summary.

Carthy ER - Ann Med Surg (Lond) (2013)

Summary of how to measure the ankle brachial pressure index (ABPI). Information obtained from NICE guidelines on peripheral arterial disease (GC 147).1
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4326116&req=5

fig0005: Summary of how to measure the ankle brachial pressure index (ABPI). Information obtained from NICE guidelines on peripheral arterial disease (GC 147).1
Mentions: Those people with symptoms suggestive of PAD, diabetes, non-healing leg or feet wounds, unexplained leg pain, those being considered for leg or foot intervention, or those using compression hosiery should be assessed for PAD. Diagnosis is initially made based on a history of leg pain on exertion, with or without additional foot and leg symptoms such as rest pain, ulcers, and tissue loss. It can also be an incidental finding in asymptomatic people attending for a general examination or diabetic foot screening. Accurate diagnosis is crucial to allow timely specialist referral and improve patient outcome, and can be diagnosed via the patient history of intermittent claudication and of symptoms of critical limb ischaemia, leg and feet examination, peripheral pulse examination, the ankle brachial pressure index (ABPI; Fig. 1; <0.9 is an indicator of PAD) and some imaging modalities not discussed in these guidelines.

View Article: PubMed Central - PubMed

Affiliation: Imperial College London Medical School, London, UK.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The following text summarises the National Institute for Health and Clinical Excellence (NICE) clinical guidelines (CG 147) on the diagnosis and management of lower limb peripheral arterial disease (PAD)... It addresses methods of diagnosis, information requirements, and lifestyle advice for the prevention of cardiovascular disease secondary to PAD, management of intermittent claudication and critical limb ischaemia, and the role of amputation in severe PAD... There is substantial evidence establishing the benefits of lowering cholesterol with PAD... In the Heart Protection Study, PAD patients with total cholesterol >3.5 mmol/L taking simvastatin had a 17.6% reduction in cardiovascular events compared with placebo... High blood pressure is associated with a three-fold increase in PAD and overall cardiovascular risk... Anti-hypertensive treatment, such as ACE inhibitors, have been found to have significant benefit on cardiovascular deaths... Accurate diagnosis is crucial to allow timely specialist referral and improve patient outcome, and can be diagnosed via the patient history of intermittent claudication and of symptoms of critical limb ischaemia, leg and feet examination, peripheral pulse examination, the ankle brachial pressure index (ABPI; Fig. 1; <0.9 is an indicator of PAD) and some imaging modalities not discussed in these guidelines... The NICE technology appraisal (TA 223) on “Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of IC in people with PAD” recommended naftidrofuryl oxalate as the preferred treatment... However, it is still unclear how effective this is when compared to other treatments such as exercise and angioplasty when patients are suitable for more than one option... People with critical limb ischaemia face enormous cardiovascular risk, with a 50% mortality rate within the first year of diagnosis... It is recommended than autologous veins are used whenever possible for people with critical limb ischaemia having infra-inguinal bypass surgery... However, there is no clearly established benefit when compared to prosthetic grafts... After discussing the treatment options with the patient, management of PAD should firstly focus on lifestyle interventions, before the vascular multidisciplinary team are involved who need to be crucially involved in interventional therapy, namely the need for angioplasty or bypass surgery... Prompt diagnosis of PAD is crucial in reducing the risk of complications and adverse events such as critical limb ischaemia.

No MeSH data available.


Related in: MedlinePlus