What are the recommended diagnostic criteria for confirming a diagnosis of Peripheral Arterial Disease (PAD) in primary care?

Recommended diagnostic criteria for confirming Peripheral Arterial Disease (PAD) in primary care include:

• Assess for symptoms suggestive of PAD such as intermittent claudication or critical limb ischaemia, or risk factors including diabetes with non-healing leg or foot wounds, unexplained leg pain, or prior consideration for leg/foot interventions or compression hosiery use.
• Perform a clinical examination of the legs and feet, including checking for ulceration and palpation of femoral, popliteal, and foot pulses.
• Measure the Ankle Brachial Pressure Index (ABPI) using a Doppler probe and appropriately sized cuffs while the patient is resting and supine. Calculate the ABPI by dividing the highest ankle systolic pressure by the highest brachial systolic pressure.
• Interpret ABPI values as follows: an ABPI less than 0.9 generally indicates PAD; values between 0.8 and 1.3 suggest arterial disease is unlikely; values below 0.5 indicate severe arterial insufficiency requiring urgent referral; values above 1.3 may indicate arterial calcification and require specialist assessment.
• In people with diabetes, do not exclude PAD diagnosis based solely on a normal or raised ABPI, as arterial calcification may falsely elevate readings. Pulse oximetry is not recommended for PAD diagnosis in diabetes.

These steps together confirm the diagnosis of PAD in primary care and guide further management or referral decisions.

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