Australian guideline on diagnosis and management of peripheral artery disease: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease

• Published in: Journal of Foot and Ankle Research
• Main Authors: Vivienne Chuter, Frank Quigley, Patrik Tosenovsky, Jens Carsten Ritter, James Charles, Jane Cheney, Robert Fitridge, on behalf of the Australian Diabetes-related Foot Disease Guidelines & Pathways Project
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2022
• Subjects: Diabetes feet; Peripheral artery disease; Foot ulcer; Guidelines; Diagnosis; Revascularisation; Diseases of the musculoskeletal system; RC925-935; First Nations
• Online Access: https://doi.org/10.1186/s13047-022-00550-7; https://doaj.org/article/b0d5b16573c84292bc7330f5d8e0ec01

Abstract Background Peripheral artery disease (PAD) is implicated in up to 50% of diabetes-related foot ulcers (DFU) and significantly contributes to morbidity and mortality in this population. An evidence-based guideline that is relevant to the national context including consideration of the unique geographical and health care system differences between Australia and other countries, and delivery of culturally safe care to First Nations people, is urgently required to improve outcomes for patients with PAD and DFU in Australia. We aimed to identify and adapt current international guidelines for diagnosis and management of patients with PAD and DFU to develop an updated Australian guideline. Methods Using a panel of national content experts and the National Health and Medical Research Council procedures, the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines were adapted to the Australian context. The guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were applied to the IWGDF guideline for PAD by the expert panel. Recommendations were then adopted, adapted or excluded, and specific considerations for implementation, population subgroups, monitoring and future research in Australia were developed with accompanying clinical pathways provided to support guideline implementation. Results Of the 17 recommendations from the IWGDF Guideline on diagnosis, prognosis and management of PAD in patients with diabetes with and without foot ulcers, 16 were adopted for the Australian guideline and one recommendation was adapted due to the original recommendation lacking feasibility in the Australian context. In Australia we recommend all people with diabetes and DFU undergo clinical assessment for PAD with accompanying bedside testing. Further vascular imaging and possible need for revascularisation should be considered for all patients with non-healing DFU irrespective of bedside results. All centres treating DFU should have expertise in, ...