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

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

Urgent referral to Vascular Surgeon

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 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 ICB- 15N

Referral Form

DRSS Referral Form

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: June 2015