Please use NHS e-Referrals to refer a patient to our vascular surgery service.

To discuss an admission or for advice and guidance regarding a patient please contact the on-call vascular consultant via Consultant Connect.

In the case of an emergency or for time critical queries, GPs should contact the on call vascular consultant by calling the hospital switchboard.

Arterial disease can be challenging to diagnose. A clear history is essential as is a complete examination. Please examine pulses proximal to distal. This section provides some guidance regarding referrals and what you can do prior to making a referral to the vascular service. The on-call vascular surgeon is always happy to provide advice and guidance.

Intermittent Claudication

Claudication is a muscular pain that comes on with exercise, it is usually predictable. It is a benign condition and does not always require a referral to the vascular service. Patients should be referred if their walking distance is unacceptable to the patient and is impacting on their quality of life.

Please use the leaflet from the Circulation Foundation to share information with the patient regarding exercise and claudication. Patients should be advised to walk a minimum of 30 minutes a day.

Please support your patient with smoking cessation, this is essential.

Please commence your patient on Clopidogrel 75mg and a Statin of your choice. This is for cardiovascular risk factor management so please advise your patient that they will not make a difference to their symptoms.

 Abnormal ABPIs

ABPI values should always be taken in the context of symptoms. For example, if the ABPI is abnormal but the person has no symptoms of peripheral arterial disease a vascular referral is not necessary. However, if you are concerned the person has symptoms of peripheral arterial disease but the ABPI is within the normal range, consider a referral to the vascular service.

• Bilateral lower limb swelling in the absence of ischaemic rest pain is not an indication for a referral to the vascular service
• Cold feet without rest pain or tissue loss is not an indication for referral to the vascular service
• Absent pulses without rest pain or tissue loss or symptoms of peripheral arterial disease is not an indication for referral to the vascular service.

Symptomatic varicose veins

Compression hosiery is a form of non-surgical treatment for varicose veins and should be commenced at the time of referral to the vascular service. If the person has palpable foot pulses please ensure that they have been measured and fitted with compression stockings when you make a referral to the vascular service. If the varicose veins are in the thigh they are going to need above knee stockings.

We do not offer routine screening or surveillance of asymptomatic carotid disease.