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Arterial Leg Ulcers

Checked: 23-03-2021 by Vicky Ryan Next Review: 23-03-2022

Referral

Patients with low ABPIs/suspected arterial ulcers should be referred to the Vascular Surgery Triage service via e-referral.

There is a Vascular HOT Clinic for more urgent concerns (e.g. infected diabetic leg or foot ulcers with vascular compromise) .

All vascular referrals should now be sent via eRS to the Vascular Surgery Triage Service Clinics are held in Southmead, BRI, WGH & Bath RUH. Referrals will be triaged on a daily basis by the vascular team and booked into appropriate clinics. Please include all relevant clinical and contact details in referrals to help facilitate the triage process.

Urgent patients can also be discussed with the vascular network office telephone 0117 414 0798 or by discussion with either the General Surgery/Vascular Surgery Registrar on call - both can be contacted via switchboard on 0117 9505050.

For advice on management on non-arterial leg ulcers then please see the Leg Ulcer section in Dermatology

Dopplers

Doppler and ABPI assessment.

Advice from the Tissue Viability Specialist Nurses (Sirona) on ABPI thresholds and when to refer are below:

ABPI less than 0.64 – refer to Wound Care Service
ABPI less than 0.5 – Urgent referral to vascular.
ABPI more than 1.3 – refer to Wound Care Service.

Resources

Please see the local Vascular Directory of Services

COVID-19 Update: The vascular service has responded to this pandemic by deferring elective surgery and offering remote (predominantly telephone) consultations. We maintain both a specialist vascular service and a diabetic foot service.

Many patients with vascular disease require emergency or urgent specialist care (see page 4 of the Directory above). Such patients should be referred as per these pathways by telephone, referapatient® or NHS e-RS Triage service. The specialist service during periods of ‘surge’ will be consultant led and referrals for advice are welcomed. Patients are at risk of life or limb loss or stroke when urgent vascular intervention is deferred.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.