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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 http://rms.kernowccg.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 HOT FOOT pathway here:

http://rms.kernowccg.nhs.uk/primary_care_clinical_referral_criteria/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:

http://rms.kernowccg.nhs.uk/rms/primary_care_clinical_referral_criteria/vascular/leg_ulcer_management

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