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 2022-07, Vol.15 (1), p.51-n/a
• Main Authors: Chuter, Vivienne, Quigley, Frank, Tosenovsky, Patrik, Ritter, Jens Carsten, Charles, James, Cheney, Jane, Fitridge, Robert
• Format: Article
• Language: English
• Subjects: Amputation; Australia; Australian aborigines; Bias; Cardiovascular diseases; Care and treatment; Confidence; Critical Pathways; Diabetes; Diabetes feet; Diabetes Mellitus; Diabetic foot; Diabetic Foot - diagnosis; Diabetic Foot - therapy; Diabetics; Diagnosis; Feet; Foot Diseases; Foot ulcer; Guidelines; Health aspects; Health care; Humans; Leg ulcers; Medical diagnosis; Medical research; Medical treatment; Medicine, Experimental; Morbidity; Mortality; Native peoples; Patients; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - therapy; Peripheral artery disease; Population; Revascularisation; Review; Ulcers; Vascular diseases; Vein & artery diseases; Working groups
• ISSN: 1757-1146; 1757-1146
• DOI: 10.1186/s13047-022-00550-7

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, and/or rapid access to facilities necessary to diagnose and treat PAD, and should provide multidisciplinary care post‐operatively, including implementation of intensive cardiovascular risk management. Conclusions A guideline containing 17 recommendations for the diagnosis and management of PAD for Australian patients with DFU was developed with accompanying clinical pathways. As part of the adaptation of the IWGDF guideline to the Australian context, recomme