Quality statement 4: Imaging

Quality statement

People with peripheral arterial disease (PAD) being considered for revascularisation who need further imaging after a duplex ultrasound are offered magnetic resonance angiography (MRA).

Rationale

Imaging should only be performed in people with PAD if it is likely to provide information that will influence their management. Duplex ultrasound followed by MRA, where clinically appropriate and if needed, offers the most accurate, safe and cost-effective imaging strategy for people with PAD. However, local training and expertise and the availability of imaging equipment may be variable.

Quality measures

Structure

(a) Evidence of local arrangements to ensure that healthcare practitioners undertaking imaging are appropriately trained in the use of duplex ultrasound and MRA for PAD.

Data source: Local data collection.

(b) Evidence of local arrangements to ensure that people with PAD being considered for revascularisation who need further imaging after a duplex ultrasound are offered MRA.

Data source: Local data collection.

Process

Proportion of people with PAD being considered for revascularisation needing further imaging after a duplex ultrasound who receive MRA.

Numerator – the number of people in the denominator receiving MRA.

Denominator – the number of people with PAD being considered for revascularisation who need further imaging after a duplex ultrasound.

Data source: Local data collection. Contained within NICE clinical guideline 147 audit support – imaging and supervised exercise programmes: audit standard 2.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that imaging equipment is adequately available, and that people with PAD who are being considered for revascularisation and need further imaging after a duplex ultrasound are offered MRA.

Healthcare practitioners ensure that they offer MRA to people with PAD who are being considered for revascularisation who need further imaging after a duplex ultrasound imaging.

Commissioners ensure that they commission services with adequate availability of imaging equipment and which offer MRA to people with PAD being considered for revascularisation who need further imaging after a duplex ultrasound.

What the quality statement means for patients, service users and carers

People with peripheral arterial disease whose healthcare practitioner thinks surgery might help to improve their blood flow, are offered imaging tests (for example, an ultrasound) to see whether surgery would be suitable.

Source guidance

Definitions of terms used in this quality statement

Revascularisation is any procedure that is used to restore blood flow to an area of the body that is supplied by narrowed or blocked arteries. This can be done either by making the narrowed arteries wider (angioplasty, stenting), or by using another blood vessel to bypass the blocked or narrowed artery (bypass surgery).

[Adapted from information for the public for NICE clinical guideline 147]

People being considered for revascularisation include those:

  • with intermittent claudication, who should be offered angioplasty only when:

    • advice on the benefits of modifying risk factors has been reinforced (see recommendation 1.2.1) and

    • a supervised exercise programme has not led to a satisfactory improvement in symptoms and

    • imaging has confirmed that angioplasty is suitable for the person

  • being considered for primary stent placement, for treating people with intermittent claudication caused by complete aorto-iliac occlusion (rather than stenosis)

  • with critical limb ischaemia who need revascularisation, who should be offered angioplasty or bypass surgery, taking into account factors including:

    • comorbidities

    • pattern of disease

    • availability of a vein for grafting

    • patient preference

  • being considered for primary stent placement, for treating people with critical limb ischaemia caused by complete aorto-iliac occlusion (rather than stenosis).

[Adapted from NICE clinical guideline 147, recommendations 1.5.3, 1.5.5, 1.6.2 and 1.6.4]