This guideline doesn’t change very much that we do already, so I am not including elements that we are all doing already. The new elements for me were:
Assess for Peripheral Arterial Disease (PAD) in:
- Non-healing Wounds
- Unexplained Leg Pain
- Going to undergo leg or foot interventions
- Compression hosiery (NB it does imply that patients having compression hosiery should have an ABPI done)
Advice given to patients:
Apart from the normal advice, it is worth emphasising that modifying risk factors and exercise really do make a difference. Apparently many patients simple do not believe this to be the case, so if you want them to engage, you need to explain this clearly.
- Clopidogrel is the antiplatelet drug of choice for PAD.
- Supervised Exercise Programme – all patients should have a 3 month programme and surgical management should only be considered after this.
- Naftidrofuryl oxalate. This should only be used after a supervised exercise programme and if they then decline surgical management.This is the only drug to be advised specifically for PAD.