When should I consider referring a patient with an arterial ulcer to a vascular specialist?

Consider referring a patient with an arterial ulcer to a vascular specialist:

• When there is suspicion or confirmation of arterial or mixed aetiology of the ulcer, as these require specialist vascular assessment and management rather than standard venous ulcer care.
• Urgently if the patient has signs of chronic limb-threatening ischaemia, such as critical limb ischaemia, non-healing ulcers, or worsening symptoms, to enable assessment by a vascular multidisciplinary team before treatment decisions.
• If there is delayed or no healing of the ulcer despite appropriate management, including after 2 weeks of compression therapy if applied, or if the ulcer deteriorates, recurs, or there is a sudden increase in size or pain.
• When the patient has peripheral arterial disease symptoms or risk factors, including diabetes with non-healing wounds, unexplained leg pain, or when considering interventions to the leg or foot.
• For further vascular imaging (duplex ultrasound, magnetic resonance angiography, or computed tomography angiography) if revascularisation is being considered.

Early referral facilitates full clinical and duplex Doppler ultrasound assessment and access to a full range of treatments, including revascularisation options if appropriate.

Referral pathways may vary locally, but vascular specialist input is essential for arterial ulcers to prevent progression to limb loss and to manage cardiovascular risk factors.

In summary, refer arterial ulcer patients promptly to vascular specialists when arterial disease is suspected or confirmed, when ulcers fail to heal or worsen, or when critical limb ischaemia is present or suspected.

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