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Peripheral Arterial Disease

Peripheral Arterial Disease

·         Critical ischaemia:

·         Rest pain, marked deterioration with acute onset rest pain, ulceration or gangrene, contact on-call vascular team in hours to arrange urgent OP appointment, or admission. Only admit via general Surgeon on-Call if problems with pain control or uncontrolled infection as high risk of amputation and death.

·         Any patient with acute onset of limb ischaemia should be referred urgently via the vascular surgeon on call, as there is high risk of amputation and death.

Possible presentation of peripheral arterial disease

Claudication or critical limb ischaemia

Delayed healing of wounds, or persistent non-healing ulceration see http://rms.kernowccg.nhs.uk/rms/primary_care_clinical_referral_criteria/vascular/leg_ulcer_management

Thin, hairless, shiny skin, arterial ulcers, gangrene

Incidental on scan

Management of intermittent claudication

Consider ABPI to confirm diagnosis

In one-third of patients symptoms resolve spontaneously

  • Encourage regular exercise
  • Smoking  cessation
  • Secondary vascular disease prevention
  • If leg injured or sore seek help early as poor healing

NICE CG 147 August 12 recommends

o    A supervised exercise programme to all people with intermittent claudication:

o    2 hours of supervised exercise a week for a 3-month period

o    encouraging people to exercise to the point of maximal pain

o    Consider naftidrofuryl oxalate for treating people with intermittent claudication, starting with the least costly preparation, only when:

  • supervised exercise has not led to satisfactory improvement and
  • the person prefers not to be referred for consideration of angioplasty or bypass surgery.
    Review progress after 3–6 months and discontinue naftidrofuryl oxalate if there has been no symptomatic benefit

Consider referral to vascular clinic if

·         Suspected PVD (especially with ABPI <0.9 or unable to do ABPI)

·         Routine refer only if limiting lifestyle and after conservative management.

Reference

NICE CG 147 August 2012