Peripheral Arterial Disease – Information for GPs
Referral criteria / commissioning position
Referral to secondary care for:
- risk factor modification
- patients with claudication which is affecting their quality of life
Most patients will not be managed with re-vascularisation but specialist assessment is needed to identify those who would benefit from angioplasty or formal bypass grafting. Exception to this would be patients with stable claudication distances whose quality of life is unaffected.
- patients with tissue loss
- suggestive of arterial cause (ulceration and/or gangrene)
Gangrene which is wet in appearance is suggestive of an additional infective process and may well need IV antibiotics. Exception to referral may be an elderly patient with dry gangrene who is unaffected by its presence.
Red flag symptoms
- Acute leg Ischaemia is the diagnosis not to miss in a patient presenting with a painful limb of sudden onset. This can be defined as a leg which has previously been stable (either totally pain free or which has had a consistent claudication distance) which demonstrates a sudden deterioration in the arterial supply over a period of less than two weeks
Investigations prior to referral
- Bloods (FBC, U&E, Cholesterol, HbA1c)
Information to include in referral letter
- Claudication distance plus any signs of rest pain or tissue loss.
- Risk factor modification has been addressed
- Treatments and interventions, current & past tried including the results
- Drug history (prescribed and non-prescribed)
- Current regular medication
- Relevant past medical/surgical history
- Smoking status
- Alcohol consumption