{"id":4270,"date":"2026-04-29T08:15:15","date_gmt":"2026-04-29T08:15:15","guid":{"rendered":"https:\/\/www.perimed-instruments.com\/us\/?p=4270"},"modified":"2026-04-29T08:15:16","modified_gmt":"2026-04-29T08:15:16","slug":"understanding-nice-htg677-and-what-it-means-for-healthcare-in-the-uk","status":"publish","type":"post","link":"https:\/\/www.perimed-instruments.com\/us\/blog\/understanding-nice-htg677-and-what-it-means-for-healthcare-in-the-uk\/","title":{"rendered":"Understanding NICE HTG677 and what it means for healthcare in the UK"},"content":{"rendered":"\n
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by Sara Gyllensporre<\/mark><\/a> (Clinical Application Specialist<\/em>)<\/p>\n\n\n\n

For more than a decade, I\u2019ve been building relationships with clinicians and gaining valuable insights into how healthcare in the UK operates. As part of our strategy to scale in key markets, we recently partnered with HC 21 UK \u2014 one of Europe\u2019s largest medtech providers. You can read more about that in this post: Strengthening vascular care across the UK<\/mark><\/a>.<\/p>\n\n\n\n

On a recent visit to the UK, I was interested to learn that some hospitals I have worked closely with are no longer using certain medical devices listed in the NICE HTG677 recommendation<\/a><\/mark>, which recognizes the need for specialists to perform and interpret ankle brachial index (ABI) measurements. In short, the guidance concludes that more research is needed, and that the evidence is currently insufficient to support the routine use of automated<\/em> ABI measurement devices<\/strong> to detect peripheral artery disease (PAD) in people with leg ulcers.<\/p>\n\n\n\n

In this post, I will unpack what that means in practice. I will explore the two factors that affect ABI measurements: the physiological side of how underlying patient conditions can influence results, as well as the technical side, including how the equipment itself, regardless of method or instrument, can impact measurement quality. And lastly, I will share my thoughts on why \u2014 beyond patient outcomes \u2014 the recommendation exists and what it means for healthcare in the UK.<\/p>\n<\/div>\n\n\n\n

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\u201cFor HC21 UK, NICE HTG677 highlights an opportunity to better support clinicians managing people with diabetes and complex wounds. By combining Perimed\u2019s PeriFlux 6000 with our local service and education, we aim to help teams strengthen vascular assessment pathways and make more informed decisions about patient care.<\/em>\u201d<\/p>\n<\/div>\n\n\n\n

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David Atkinson, Business Development Director \u2014 HC21 UK,<\/p>\n\n\n <\/div>\n <\/section>\n\n\n

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Leg ulcers and PAD<\/h3>\n <\/div>\n\n\n\n

I think it\u2019s important to put the recommendation into context. It specifically addresses the detection of peripheral artery disease (PAD) in people with leg ulcers<\/strong>. In other words, non-trivial diagnoses of complex patients with potential comorbidities.<\/p>\n\n\n\n

As the recommendation explains, the rationale stems from the widespread use of compression therapy for leg ulcers. While effective, compression is not always an appropriate treatment. For individuals with underlying PAD, compression can further compromise blood flow to the limb, with potentially serious complications.<\/p>\n<\/div>\n\n\n <\/div>\n <\/section>\n\n\n

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Why measure microcirculation<\/h3>\n <\/div>\n\n\n\n

One of the positives with ABI is that it is a noninvasive way to assess arterial status, but it has its limitations. While low ABI is indicative of PAD, a normal ABI does not exclude it.<\/p>\n\n\n\n

In some individuals, ABI may appear normal because blood can find alternative pathways around blockages. Arterial stiffness, which becomes more common with age and in people with diabetes or chronic kidney disease, can also affect the measurement. In these cases, ABI values may be falsely elevated because stiff arteries do not compress properly, causing ABI values to fall within the normal range despite underlying disease.   <\/p>\n\n\n\n

In isolation, ABI is not always reliable. It reflects large-vessel blood flow but does not capture tissue-level perfusion where healing occurs. Measuring microcirculation helps address this gap as it can reveal ischemia and provide deeper insights into healing potential and tissue viability.<\/p>\n\n\n\n

Why then does the NICE recommendation focus on the technology rather than the inherent limitations of the measurement? My theory is the apparent simplicity of modern devices.<\/p>\n<\/div>\n\n\n <\/div>\n <\/section>\n\n\n

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The shift to the home \u2014 at what cost? <\/h3>\n <\/div>\n\n\n\n
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The proliferation of devices for home- and community-based care is both inevitable and desirable. Driven by advances in technology and the growing need to support care at home and in remote settings, new devices are shifting diagnostics out of specialist environments and into settings closer to patients.  <\/p>\n\n\n\n

While this shift helps lower the burden on healthcare systems, it introduces a subtle challenge:<\/p>\n\n\n\n

The assumption that ease of use equates to measurement reliability.<\/strong><\/p>\n<\/div>\n<\/div>\n\n\n\n

In the context of ABI, this assumption does not always hold.<\/p>\n\n\n\n

Automated devices make it possible for almost anyone to take a measurement. The process appears simple: wrap a cuff around the limb, press a button, and read the result. However, alongside underlying physiological factors that can affect ABI accuracy, several additional parameters come into play, including:<\/p>\n\n\n\n