What are the indications for referring a patient with PAD to a vascular specialist?

Indications for referring a patient with peripheral arterial disease (PAD) to a vascular specialist include:

• Urgent referral for all people with chronic limb-threatening ischaemia to a vascular multidisciplinary team, unless clinical judgement deems this inappropriate (e.g., palliative care) ¹.
• Referral for specialist vascular assessment if the ankle brachial pressure index (ABPI) is less than 0.5, indicating severe arterial insufficiency ³.
• Referral for specialist vascular assessment if the ABPI is between 0.5 and less than 0.8, suggesting arterial or mixed arterial/venous disease ³.
• Referral for specialist vascular assessment if the ABPI is above 1.5, as vessels may be incompressible and results unreliable, especially in people with diabetes or other conditions causing arterial calcification ³.
• Referral for consideration of revascularisation in people with PAD when symptoms are severe, lifestyle-limiting, or when supervised exercise and risk factor modification have not led to satisfactory improvement ².
• Referral for imaging (duplex ultrasound first-line) when revascularisation is being considered ².
• Referral for specialist pain management if critical limb ischaemic pain is not controlled and revascularisation is inappropriate or impossible, or if pain persists after revascularisation or amputation ¹,².

These indications ensure timely specialist assessment and management to prevent limb loss and improve outcomes in PAD patients.