Evidence

Surveillance report 2017 – Peripheral arterial disease: diagnosis and management (2012) NICE guideline CG147

Surveillance decision

Surveillance decision

We will plan an update of the following sections of the guideline:

  • Diagnosis – assessment

Reason for the decision

Assessing the evidence

We found 54 new studies through surveillance of this guideline. Evidence that could affect recommendations was identified. Topic experts, including those who helped to develop the guideline, advised us about whether the following sections of the guideline should be updated.

Diagnosis of peripheral arterial disease

  • In people with suspected peripheral arterial disease (PAD), is ankle brachial pressure index (ABPI) as an adjunct to clinical assessment better than clinical assessment alone or ABPI alone, in determining the diagnosis and severity of PAD?

New evidence on diagnosis of PAD among people with diabetes suggests that other forms of assessment may be superior to ABPI for diagnosing PAD in patients with diabetes. Currently, the recommendation suggests the ABPI measurement as an assessment tool in people with suspected PAD. Topic experts agreed that the new evidence should be reviewed looking specifically at people with diabetes as the value of ABPI might differ in those with diabetes.

Decision: This review question should be updated, specifically for people with diabetes.

Other clinical areas

We found new evidence that supports current recommendations on:

  • endovascular or surgical techniques compared to or in combination with exercise or best medical treatment for the treatment of people with intermittent claudication

  • angioplasty compared to bypass surgery or amputation for the treatment of critical limb ischaemia in adults with PAD.

We also found new evidence that was not thought to have an effect on current recommendations on:

  • imaging for revascularisation in peripheral arterial disease

  • clinical and cost effectiveness of bare metal stents compared to drug-eluting stents for the treatment of PAD in adults with intermittent claudication

  • clinical and cost effectiveness of bare metal stents compared to drug-eluting stents for the treatment of PAD in adults with critical limb ischaemia.

We did not find any new evidence related to:

  • information requirements for people with peripheral arterial disease

  • management of ischaemic pain in critical limb ischaemia

  • major amputation for critical limb ischaemia.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the new evidence and views of topic experts, we decided that a partial update is necessary for this guideline.

See how we made the decision for further information.


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