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Atherosclerotic Peripheral Vascular Disease G007

Document
Last amended 
28 July 2016
Current RMA Instruments
Reasonable Hypothesis SOP23 of 2012
Balance of Probabilities SOP 24 of 2012
Changes from previous Instruments

SOP Bulletin 157

ICD Coding
  • ICD-9-CM Codes:440.2
  • ICD-10-AM Codes: I70.2
Brief description

Atherosclerotic peripheral vascular disease (PVD) is partial or complete occlusion of arteries that supply the upper or lower limbs, due to atherosclerosis, and resulting in clinical manifestations (symptoms or signs).  The condition involves the arteries distal to the aorta (iliac, femoral, popliteal etc. (lower limb) and subclavian, axillary, brachial etc. (upper limb)).  The lower limbs are more commonly affected.  Narrowing of the aorta due to atherosclerosis, with claudication (pain on exertion) or other lower limb manifestations, is covered by a separate SOP - for non-aneurysmal aortic atherosclerotic disease.

Confirming the diagnosis

The diagnosis can be made based on the clinical presentation, typically including measurement of an ankle-brachial index (ABI) of ≤0.9 for lower limb disease.  Ultrasonography or other imaging is usually undertaken to determine the location and severity of the occulusion.

The relevant medical specialist is a vascular surgeon.

Additional diagnoses covered by SOP

Ulceration or gangrene of the limbs due to atherosclerotic PVD is covered by the SOP (rather than treated as a sequelae).

Related conditions that may be covered by SOP (further information required)

Intermittent claudication

Conditions not covered by SOP
  • Buerger’s disease#, ICD code 443.1
  • Deep venous thrombosis*
  • Neurogenic intermittent claudication (due to spinal stenosis), ICD code 724.02
  • Non-aneurysmal aortic atherosclerotic disease*
  • Raynaud’s disease#, ICD code 443.0
  • Varicose veins of the lower limb*

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

The condition may be asymptomatic and detected on clinical examination, in which case onset will be at the time of diagnosis.  For symptomatic disease, typically presenting with claudication, clinical onset can be backdated to the commencement of relevant symptoms, once the diagnosis has been confirmed.

Clinical worsening

The clinical course is variable, but without treatment slow progression is usual.  Appropriate therapy (e.g. lifestyle/risk factor modification and medications) can stabilise the condition or slow its progression.  Limb threatening ischaemia may require procedures to improve or re-establish blood flow, including surgery.  Clinical worsening beyond the normal course may be evidenced by an acceleration or sudden deterioration of the condition.