Lower limb occlusive arterial disease in the North of England: Workload and development of management guidelines

Background: in 1997 the vascular surgeons across the North of England commenced a study to examine,nine various aspects of the management of lower limb occlusive arterial disease (LLOAD). Two aspects of this work were to assess workloads between hospitals and develop guideline parameters for managing intermittent claudication (IC) and critical limb ischaemia (CLI). The guidelines were to be developed, tested and modified by this study. Method: prospective inclusion of all patients admitted for investigation of LLOAD to nine hospitals by 19 surgeons over a period of 12 months. Results: the hospitals admitted an average of 106 legs per 100 000 population (range 53-149) with LLOAD. Legs with IC (n = 1351) were revascularised slightly less frequently than predicted (actual 76%, guideline 80%) and radiological treatment was used more frequently than predicted (radiology/surgery, actual 69/32%, guideline 40/60%). For limbs with CLI, revascularisation was undertaken move often (actual 70%, guideline 60%) and radiological intervention used more frequently (radiology/surgery, actual 45/58%, guideline 35/65%) than anticipated. Primary amputation, overall mortality and limb salvage were better than the predicted guidelines. Conclusion: large variations in workloads and clinical practice were observed between hospitals for the management of LLOAD. Developing guidelines for the management of limbs with IC was not considered appropriate, whereas suitable guidelines for legs with CLI were developed, tested and modified.