Peripheral Arterial Disease
Peripheral Arterial Disease
Critical ischaemia:
Any patient with acute onset of limb ischaemia should be referred urgently via the vascular surgeon on-call, as there is high risk of amputation and death.
Rest pain, marked deterioration with acute onset rest pain, ulceration or gangrene, CONTACT ON-CALL VASCULAR TEAM in hours to arrange urgent OP appointment, or admission.
Admit via the surgical out-of-hours team if overnight there are problems with pain control or uncontrolled infection
Possible presentation of peripheral arterial disease
Claudication, ulceration, gangrene, thin hairless shiny skin or critical limb ischaemia. Diabetics and other arteriopaths are more at risk.
Delayed healing of wounds, or persistent non-healing ulceration
https://rms.cornwall.nhs.uk/rms/primary_care_clinical_referral_criteria/vascular/leg_ulcer_management
Assess patients with diabetes for peripheral vascular disease if they havenon-healing wounds on the legs or feet or unexplained leg pain. Use the DIABETIC FOOT pathway here:
https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/diabetes/diabetic_feet
Management of intermittent claudication
See
https://www.nice.org.uk/guidance/cg147/chapter/Recommendations
Consider routine referral to vascular if:
1.Ulcers are not healing and they meet the criteria here:
2. Confirmation of diagnosis is required (eg symptomatic but unable to do ABPI)
3. Symptoms limit lifestyle and conservative management has failed
Please ONLY refer for consideration of surgery if the patient is FIT for surgery
Reference
https://www.nice.org.uk/guidance/cg147
Updated Diabetic Foot pathway link 24/12/2019
Version 2.1