COVID-19: Vascular service guide

May 2020

Scope

This information provides guidance on the management of vascular patients across Eastern Devon during the Covid-19 pandemic. The information is based on the Vascular Society recommendations

National guidance

Vascular society: COVID-19 virus and vascular surgery

Urgent advice/ Emergencies

Please call the on-call vascular surgeon (available 24 hours) via switchboard telephone: 01392 411611

Urgent vascular referrals include;
  • acute limb ischaemia
  • suspected ruptured AAA
  • diabetic foot sepsis requiring admission

All vascular emergencies are treated at the Royal Devon and Exeter Hospital (Vascular Hub)

Urgent referrals

Critical limb ischaemia (rest pain & tissue loss):
  • will be considered for revascularisation
Symptomatic carotid stenosis (e.g. amaurosis fugax, TIA, CVE):
  • will be considered for endarterectomy
  • many will be managed with best medical therapy only
Abdominal aortic aneurysm (AAA):
  • will be considered for treatment on a case by case basis (as is currently the case, e.g. if meet size criteria or symptomatic)
  • current guidance for urgent referral is greater than 5.5cm. However, the size threshold for surgery may be significantly higher than this and needs to weigh up risk of rupture in the next few months with risk of intervention and resource limitation. The Vascular Society is currently recommending greater than 7cm or imminent rupture.
  • Abdominal Aortic Aneurysm (AAA) Clinical Referral Guideline
Varicose Veins with significant bleeding:

Urgent ambulatory clinics with one-stop duplex imaging are available in both Exeter and Torbay (4 clinics per week).

Patients to be booked only by vascular consultants after discussion

Risk factors for face-to-face review will be decided on case by case basis.

Routine referrals

  • Asymptomatic carotid stenosis
  • Intermittent Claudication
  • Varicose vein surgery without significant bleeding

All new routine referrals will be clinically triaged and will either be added to a waiting list or, if appropriate, A&G will be given.

Please ensure that a practice-based system is in place to check daily for returning referrals with A&G.

Prior to making a routine referral, please ensure that any appropriate Policy or CRG has been reviewed and that all the suggested investigations and management options have been considered:

Existing new and follow-up routine appointments have been cancelled and changed to telephone / video consultation where appropriate.

COVID-19 High risk patient advice

Vascular emergencies in the presence of symptoms of COVID-19 will be assessed and tested along hospital guidelines in A&E at the Royal Devon and Exeter Hospital.

RD&E contact information

Please call the on-call vascular surgeon (available 24 hours) via switchboard telephone: 01392 411611

Supporting information

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Last updated: 13-05-2020

 

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