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

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 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