Background: Peripheral Arterial Disease (PAD) causes significant health and economic burden.
Nice guidelines recommend performing Doppler US (DUS) as the first line in all patients with PAD for whom re-vascularization is being considered. MRA should be performed if further imaging is needed before re-vascularization and CT angiography (CTA) is indicated only if MRA is not tolerated or contraindicated.
Some published studies showed superiority of contrast enhanced MRA over conventional diagnostic angiography.
On the basis of these guidelines and the published literature diagnostic invasive lower limb angiography should not be routine practice because of the risks and the costs implications.
We performed a study to identify the adherence in our unit to these guidelines and the resulting impact on patient safety and service provision costs.
Methods: Retrospective data collection in a single large UK tertiary referral centre. Fifty-eight patients who underwent lower limb bypass surgery were included over a time period from June 2015 to June 2016.
Results: 75% of the patients (N: 44) had DUS as a first investigation, 29% (N: 17) had CTA or MRA as a second investigation and 39% (N: 23) of the patients had diagnostic angiography preoperatively with an overall complication rate (diagnostic and therapeutic angiography) of 12%.
The estimated costs of the angiographies during the one-year period were £28,934 (£1,258 per patient).
Conclusion: Significant percentage of the patients going for lower limb bypass surgery are subject to unnecessary risk due to pre-operative diagnostic angiography with an overall increase in service costs. This is unjustified in the view of the current National guidelines and published literature.