What are the indications for referring a patient with PAD to a vascula

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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) .
Referral for specialist vascular assessment if the ankle brachial pressure index (ABPI) is less than 0.5, indicating severe arterial insufficiency .
Referral for specialist vascular assessment if the ABPI is between 0.5 and less than 0.8, suggesting arterial or mixed arterial/venous disease .
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 .
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 .
Referral for imaging (duplex ultrasound first-line) when revascularisation is being considered .
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 ,.

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

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