Synopsis
Select and interpret arterial imaging that answers a defined revascularisation question while controlling contrast, radiation and procedural risk.
- Order anatomical imaging when revascularisation is genuinely being considered, not merely because peripheral arterial disease has been diagnosed.
- NICE recommends duplex ultrasound first for people being considered for peripheral arterial revascularisation.
- If duplex is insufficient, NICE next recommends contrast-enhanced magnetic resonance angiography when it is suitable.
Key red flags
New motor weakness, sensory loss or a cold mottled limb indicates threatened acute ischaemia and demands immediate vascular assessment.
Rest pain, non-healing ulceration or gangrene with objective arterial disease suggests chronic limb-threatening ischaemia and requires urgent vascular referral.
Diabetic foot ulceration with limb ischaemia, sepsis, suspected deep infection or gangrene requires immediate acute-service referral under NICE NG19.
Rapid renal deterioration, previous severe contrast reaction or a non-compatible implant materially changes the imaging plan and needs senior radiology input.
Rest pain, ulceration or gangrene with objective PAD requires a complete distal map if limb-salvage revascularisation is feasible.
Abrupt sensory or motor change, severe pain and a cold mottled foot require emergency vascular care rather than the elective imaging sequence.
Investigation priorities
Provide first-line anatomical and haemodynamic mapping when revascularisation is being considered.
Management branches
PAD is established and the team is deciding whether anatomical intervention should be offered.
- Define the syndrome, functional or tissue threat, physiological evidence, previous therapy, procedural fitness and the patient’s goals before ordering a map.
- Use duplex first under NICE CG147 and state whether the question concerns inflow, a target lesion, distal runoff, access or conduit.