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.

  • acute limb ischaemia
  • chronic limb threatening ischaemia with tissue loss (ulcer or gangrene) and severe infection
  • sudden onset claudication or sudden significant reduction in claudication distance - please contact on call registrar to discuss clinical concerns
  • chronic limb threatening ischaemia with tissue loss (ulcer and gangrene) and mild or moderate infection - please contact on call vascular registrar to discuss clinical concerns

If your patient is in a life-threatening situation and requires immediate emergency care, call triple zero (000) or visit the nearest emergency department.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the Vascular Registrar on call 24 hours a day, 7 days a week.

For patients who are unstable and require immediate assessment, please refer to the ‘Referral to emergency’ section.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • asymptomatic / minimally symptomatic (claudication distance > 200 m) peripheral arterial disease

Triage categories

Please be aware your patient may be assessed and managed in a nurse led clinic.

Category 1 — appointment clinically indicated within 30 days

  • chronic limb threatening ischaemia (CLTI), which includes patients with peripheral arterial disease and tissue loss (ulcers present for more than two weeks or presence of gangrene) or rest pain
  • claudication ≤ 20 m distance
  • popliteal aneurysm ≥ 2 cm

Category 2 — appointment clinically indicated within 90 days

  • claudication of < 20 m to 50 m distance OR if unable to work
  • asymptomatic peripheral aneurysm < 2 cm

Category 3 — appointment clinically indicated within 365 days

  • claudication of > 50 m to 200 m distance

Vascular outpatient services accept statewide e-Referrals. For information on e-Referral forms and how to import them, or to download referral forms, please view general referral information.

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.

  • symptoms - onset, duration, claudication distance, rest pain, tissue changes (ulcers, gangrene)
  • risk factors - smoking status, diabetes (glycated haemoglobin (HbA1c)), chronic kidney disease (latest creatinine and estimated glomerular filtration (eGFR) within 6 weeks of referral), other comorbidities
  • physical exam
    • peripheral pulses
    • ankle-brachial index (ABI) if available
  • best medical therapy - please state if patient is on antiplatelet/anticoagulant and statin, previous vascular interventions
  • complete past medical history
  • current medication list
  • smoking status - if active smoker, strongly consider referral for smoking cessation
  • body mass index (BMI)
  • identifies as Aboriginal and/or Torres Strait Islander
  • identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements

Additional information to assist triage categorisation

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

Clinical management advice

Although the vascular surgery services consults with select regional sites, due to variable availability, it is recommended to contact the relevant metropolitan Local Health Network in the first instance for urgent clinical advice or referrals.

For patients who are unstable and require immediate assessment, please refer to the ‘Referral to emergency’ section.

Effective management of peripheral artery disease includes both lifestyle modifications and pharmacological interventions. Risk factor management in peripheral arterial disease (PAD) is essential for treatment and improving long-term outcomes and can significantly reduce major adverse cardiovascular events, improve limb outcomes, slow disease progression, and enhance quality of life.

Recommended interventions

  • For all patients with documented peripheral arterial disease, high intensity statin (rosuvastatin or atorvastatin) treatment is recommended, unless contraindicated, to reduce the risk of major cardiovascular events, limb events, and disease progression. Aim to achieved low density lipoprotein cholesterol (LDL) concentrations to < 1.4 mmol/L.
  • Patients with symptomatic peripheral arterial disease should be prescribed antiplatelet therapy (either aspirin or clopidogrel) unless they have a contraindication or are already taking anticoagulation medication.
  • Active blood pressure management
  • Smoking cessation is strongly recommended, particularly prior to surgery, due to significant benefits in perioperative outcomes. Consider a smoking cessation program.
  • Screening for obesity, metabolic syndrome, and diabetes, with subsequent optimal management such as referral to dietitian, diabetes educator, exercise physiology, physiotherapist, psychologist, for example.
  • Lifestyle modification should be strongly encouraged — increased activity, dietary management, weight management, smoking cessation, alcohol intake. Consider referrals to appropriate allied health services in community.

For patients with intermittent claudication, a stepwise approach is recommended, providing risk factor management, best medical treatment, and exercise therapy as a first step. Revascularisation is generally not recommended but can be considered for compliant patients with continued disabling limb symptoms despite conservative therapy.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.