Noninvasive assessments for identifying peripheral artery disease described within guidelines, consensus, and best practice statements: A rapid systematic review

Peripheral artery disease (PAD) affects approximately 4% of adults and is associated with lower-limb pain, reduced function, ulceration, amputation, and an increased likelihood of cardiovascular events. Noninvasive vascular testing methods are essential for accurate diagnosis to enable clinicians to deliver appropriate management. Clinical guidelines, consensus statements, and best practice documents are commonly used to guide practice. The quality of these documents, how well they specify the populations requiring screening, assessment, and the most appropriate noninvasive tests to use when diagnosing PAD is currently unclear. This rapid systematic review identified 37 national and international guidelines, consensus statements, or best practice documents that included information on noninvasive assessments for PAD diagnosis published up to 2025. The quality of these documents was assessed using the Appraisal of Guidelines for Research and Evaluation Instrument 2 or Joanna Briggs Institute (JBI) appraisal checklist for textual evidence (policy/consensus guidelines), and scores varied substantially, with contemporary documents generally yielding higher scores. Common reasons for lower scores were a lack of systematic methods used to derive recommendations and inadequate engagement with key stakeholders, such as end-users. Within the documents, signs and symptoms of PAD consistently listed as indicators for further vascular assessment were intermittent claudication, rest pain, gangrene, and nonhealing wounds. Other prompts for vascular assessments were traditional cardiovascular risk factors, with some newer guidelines highlighting additional risk factors such as end-stage renal disease, First Nations ancestry, and lack of physical activity. There was varying guidance on the use and interpretation of the tests. Many documents did not consider the changes in diagnostic performance that occur in noninvasive tests in people with diabetes or renal disease. Some newer documents included clinical assessment pathways, which were considered beneficial in simplifying the assessment and interpretation process for clinicians. Although some high-quality documents with strong evidence-based recommendations were identified, there was a gap in comprehensive guidance that could be applied in a variety of settings and patient cohorts. Therefore, the development of an evidence-based, co-designed comprehensive guidance document for noninvasive vascular assessment is warranted.