Current RMA Instruments
| Reasonable Hypothesis SOP | 070 of 2020 |
| Balance of Probabilities SOP | 071 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 440.2
- ICD-10-AM Codes: I70.2
Brief description
Peripheral artery disease (PAD) 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) or warranting medical treatment. 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 PAD 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#
- Deep venous thrombosis*
- Neurogenic intermittent claudication (due to spinal stenosis)
- Non-aneurysmal aortic atherosclerotic disease*
- Raynaud’s disease#
- 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 commencement of treatment. 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.