What’s the best way to assess lower limb peripheral arterial disease?

Peripheral arterial disease (PAD) can cause pain on walking and ischaemia resulting in pain when resting, ulceration and gangrene.

One in five people over the age of 65 is thought to have PAD. Risk factors for PAD include smoking, hypertension and diabetes. It is vital that the severity of the disease is accurately assessed as the best choice of treatment depends on how advanced the disease is.

Contrast angiography, the reference standard diagnostic test, is associated with adverse events related to arterial puncture, ionising radiation, and the injection of contrast agents needed to produce the images. Other imaging tests are available and include ultrasound, magnetic resonance and computed tomography (CT) angiography scans.

This systematic review assessed the research literature on the diagnostic accuracy of these different imaging techniques. When comparing the different tests, the review found that magnetic resonance angiography had the best overall diagnostic accuracy, and is generally preferred by patients over conventional contrast angiography.

However, it was not possible to compare the tests based on which gave patients the best outcomes as there was too little research available that measured this aspect.

Further information can be obtained from Alison Booth, Tel: 01904 321048; email: ab42@york.ac.uk