Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • sudden onset claudication or sudden reduction in claudication distance: please contact on call registrar to discuss clinical concerns
  • active infection +/- wet gangrene +/- foot ulceration with infection and systemically unwell or febrile, rapidly spreading cellulitis
  • active infection in foot +/- leg in patients with known PAD
  • active infection in foot ulceration +/- in patients with known diabetes
  • acute arterial/limb ischaemia

It is strongly advised that after hours presentations attend the Royal Adelaide Hospital or Flinders Medical Centre emergency departments.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • peripheral aneurysm ≥ 2 cm
  • critical limb threatening ischaemia symptoms including gangrene, ulcer, rest pain
  • claudication ≤ 20 m distance

Category 2 — appointment clinically indicated within 90 days

  • asymptomatic peripheral aneurysm < 2 cm
  • claudication > 20 m and < 200 m distance

Category 3 — appointment clinically indicated within 365 days

  • claudication > 200 m and < 500 m distance
  • vascular malformation
  • vasospastic disorders including:
    • Raynaud’s disease
    • acrocyanosis

For more on outpatient referrals, see the general referral information page.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • complete past medical history
  • current medication list
  • presence/absence pulses: dorsalis pedis/posterior tibial/popliteal
  • previous risk factor management - including statin and antiplatelet agents/exercise programs
  • claudication walking distance in metres
  • rest pain if present
  • identifies as Aboriginal or Torres Strait Islander
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
  • haemodialysis or peritoneal dialysis dependent
  • ulcer presentation
  • body mass index

Additional information to assist triage categorisation

  • complete blood count (CBE)
  • urea, electrolytes and creatinine test (UEC)
  • liver function tests (LFT)
  • estimated glomerular filtration rate (eGFR)
  • glycated haemoglobin test (HbA1c) 
  • Ankle Brachial Pressure Index
  • wound microscopy, culture, sensitivity (MCS) (if clinical signs of infection present)
  • relevant cardiac investigation reports (if previously completed)

Clinical management advice

  • examine both feet for evidence of the following risk factors (consider high risk foot referral):
    • neuropathy
    • ulceration
    • callus
    • infection and/or inflammation
    • deformity
    • gangrene
    • non-active Charcot arthropathy
    • peripheral pulses foot/ankle/calf
  • evidence-based exercise programs are for patients with PAD in lower limbs, and should be encouraged in association with risk factor management in the community

Clinical resources

Consumer resources