Richtlijn 'Diagnostiek en behandeling van arterieel vaatlijden van de onderste extremiteit' van de Nederlandse Vereniging voor Heelkunde

The guideline 'Diagnosis and treatment of peripheral artery disease of the lower extremities' describes the diagnostic work-up and treatment of patients with peripheral artery disease of the legs. The text is the result of a cooperative effort of the Dutch Society of Vascular Surgery and the Section of nterventional Radiology of the Dutch Society of Radiology. A diagnosis of 'peripheral artery disease' can be made by measuring the ankle/brachial index. Additional investigations are only necessary ifa plan for invasive treatment must be drawn up. The first line of treatment in patients with intermittent claudication is walking exercise. If the results are unsatisfactory, percutaneus transluminal angioplasty (PTA) or surgery can be performed. In case of critical ischaemia, revascularisation is mandatory to prevent an amputation. In selected cases, percutaneous intentional endovascular revascularisation is a good alternative to bypass surgery. In patients with acute ischaemia in whom the vitality of the leg is not threatened, intra-arterial thrombolysis can be carried out as an alternative to surgery. An inhibitor of platelet aggregation such as acetylsalicylic acid and a statin should be prescribed to patients with peripheral artery disease. Only in case of venous bypass surgery should a coumarin derivative and a statin be prescribed for 2 years, while the bypass is controlled periodically for 6 months by duplex examination