Quality statement 5: Angioplasty for intermittent claudication

Quality statement

People with intermittent claudication are offered angioplasty only when imaging has confirmed it is appropriate, after advice on the benefits of modifying risk factors has been given, and after a supervised exercise programme has not improved symptoms.

Rationale

Angioplasty can be used to treat intermittent claudication, but it is an invasive procedure and should only be used after non-invasive options (including reinforcement of the importance of lifestyle changes and participation in supervised exercise programmes) have not improved symptoms, and imaging has confirmed that angioplasty is suitable. Greater use of non-invasive treatments may reduce the need for angioplasty and improve overall outcomes for peripheral arterial disease (PAD).

Quality measures

Structure

Evidence of local arrangements to ensure that people with intermittent claudication are offered angioplasty only when imaging has confirmed it is appropriate, advice on the benefits of modifying risk factors has been given and a supervised exercise programme has not improved symptoms.

Data source: Local data collection.

Process

Proportion of people with intermittent claudication receiving angioplasty who have had imaging to confirm angioplasty is appropriate, received advice on the benefits of modifying risk factors and undergone a supervised exercise programme that did not improve symptoms.

Numerator – the number of people in the denominator who have had imaging to confirm angioplasty is appropriate, received advice on the benefits of modifying risk factors and undergone supervised exercise programme that did not improve symptoms.

Denominator – the number of people with intermittent claudication who receive angioplasty.

Data source: Local data collection.

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

Service providers ensure that supervised exercise programmes are adequately available and have local protocols in place to ensure healthcare practitioners only offer angioplasty to people with intermittent claudication when imaging has confirmed it is appropriate, advice on the benefits of modifying risk factors has been given and a supervised exercise programme has not improved symptoms.

Healthcare practitioners ensure that they offer angioplasty to people with intermittent claudication only when imaging has confirmed it is appropriate, advice on the benefits of modifying risk factors has been given and a supervised exercise programme has not improved symptoms.

Commissioners ensure that they commission services in which people with intermittent claudication are only offered angioplasty when imaging has confirmed it is appropriate, advice on the benefits of modifying risk factors has been given and a supervised exercise programme has not improved symptoms.

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

People who have pain when walking because of poor circulation are offered angioplasty (a procedure in which a small balloon is inserted into the narrowed artery and inflated to widen the artery) only when an imaging test has confirmed that angioplasty is suitable, and advice on the risk factors of peripheral arterial disease and a supervised exercise programme have not improved symptoms.

Source guidance

Definitions of terms used in this quality statement

Intermittent claudication is defined as a walking- or exercise-induced pain in the lower limbs caused by diminished circulation. [Full NICE clinical guideline 147]