Peripheral Vascular Disease

Scope

  • Peripheral Vascular Disease or Peripheral Arterial Disease is a common condition in which a build-up of fatty deposits in the arteries restricts blood supply to leg muscles

Assessment

Signs and Symptoms

Suggestive of peripheral vascular disease / claudication

  • Calf / thigh / buttock pain
  • Onset at constant distance
  • Worse on incline
  • Relieved by rest

History and Examination

Presence of chronic wound

Clinical Assessment

  • History:
    • Diabetes / hypertension / renal impairment
  • Smoking
  • Examination / ABPI (Caution in diabetics)
  • Evidence of arterial disease / absent pulses
  • Presence of varicose veins
  • Base line investigations FBC / U&E / cholesterol

Differential Diagnoses

Palpable distal pulses / ABPI greater than 0.9

  • Consider alternative diagnosis
  • Musculo skeletal / spinal stenosis

Red Flags

  • Nocturnal pain or rest pain
  • Pain relieved by dependency
  • ABPI less than 0.6
  • +/- Distal ulceration or gangrene

Urgent referral to Vascular Surgeon

Management

Mild Symptoms / few limitations in lifestyle

ABPI greater than 0.6 less than 0.9

Assess Cardio-Vascular Risk

  • Blood pressure (less than 130/80)
  • Aim for HbA1c less than 7%
  • Start statin
  • Smoking cessation.
  • Aspirin 75mg
  • Avoid betablockers if possible

Monitor progress 4 – 6 months

  • If improvements in symptoms – continue
  • If stable / adjust lifestyle to symptoms – continue
  • If symptoms deteriorate or unwilling / unable to adjust lifestyle refer to vascular clinic

Referral

Referral Criteria

Mild Symptoms / few limitations in lifestyle
  • See management
Moderate to severe symptoms, severe limitations in lifestyle, short walking distance ABPI greater than 0.6, less than 0.9
  • Assess Cardio-Vascular Risk
    • Blood pressure (less than 130/80)
    • Aim for HbA1c less than 7%
    • Start statin
    • Smoking cessation.
    • Aspirin 75mg
    • Avoid betablockers if possible
  • Refer to Vascular clinic

Referral Instructions

Refer using e-Referrals service selection:

  • Service: Surgery – Vascular
  • Clinic type: Arterial
  • Service: DRSS-Northern-Surgery Vascular- Devon CCG- 15N

Referral Forms

DRSS referral form

Supporting Information

Pathway Group

This guideline has been signed off by the Northern Locality on behalf of NEW Devon CCG.

Publication date: June 2015

 

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