Synopsis
Choose endovascular or open lower-limb revascularisation from clinical indication, patient risk, anatomy, conduit, durability and informed goals.
- Treat the patient’s syndrome and goals, not a percentage stenosis or an attractive technical image.
- Stable claudication usually needs risk reduction and supervised exercise before invasive treatment is justified.
- NICE offers angioplasty for claudication only after non-invasive treatment is unsatisfactory and imaging confirms suitability.
Key red flags
Acutely painful, cold, pale or neurologically impaired limb before or after treatment needs immediate vascular assessment.
Expanding access-site swelling, hypotension, flank or abdominal pain after catheter intervention may indicate major or retroperitoneal bleeding.
Disproportionate limb pain, pain on passive movement, tense compartments or neurological loss suggests compartment syndrome.
Fever, graft exposure, groin wound breakdown or sepsis after bypass raises concern for graft infection and requires urgent specialist care.
Objective ischaemia accompanies rest pain or tissue loss, the limb remains reconstructible, and meaningful healing or function is achievable.
New pain, pulse loss, sensory change, weakness or wound deterioration after treatment suggests thrombosis, embolisation or inadequate perfusion.
Investigation priorities
Confirm that PAD explains symptoms or tissue threat before selecting anatomy-driven treatment.
Management branches
PAD causes disabling claudication or limb threat and a procedure may improve a meaningful outcome.
- Confirm the clinical indication, objective ischaemia, patient goal and response to appropriate non-invasive treatment before reviewing the angiogram.
- Assess physiological reserve, life expectancy, wound and infection severity, lesion distribution, distal target, conduit and centre capability.