9 Peripheral Vascular Disease

Peripheral arterial disease commonly presents as intermittent claudication, which is pain in the calf that occurs on walking and which is relieved by rest. More severe forms of peripheral arterial disease present as rest pain, gangrene or ulceration, occasionally leading to amputation. Abdominal aortic aneurysms commonly remain asymptomatic but sometimes rupture with a high risk of death. Symptomatic aneurysms and large asymptomatic aneurysms require surgical repair because of an increased risk of rupture. Health service issues that are currently important in meeting the needs of patients with these peripheral vascular diseases are, in primary care, the appropriate management of cardiovascular risk factors and referral of patients with intermittent claudication. In secondary care, key issues are the centralisation of services around major vascular units at regional and supra-district level and the minimum facilities that should be provided in these units. In the clinical management of patients, the diagnosis and treatment of claudication, the use of interventional radiology and reconstruction surgery, and the management of asymptomatic aneurysms are important. Also, the value of screening, particularly for asymptomatic aneurysms, has been debated in recent years. A key problem for purchasers at present is the specification of theminimum requirements for providing a vascular service at secondary care level. Whether or not to screen for aortic aneurysms is another important issue.