What are the key clinical signs that indicate a patient may require referral to vascular surgery for suspected peripheral arterial disease?

Key clinical signs indicating referral to vascular surgery for suspected peripheral arterial disease (PAD) include:

• Presence of symptoms suggestive of PAD such as intermittent claudication or critical limb ischaemia, including rest pain, ulceration, or non-healing wounds on the legs or feet.
• Evidence of critical limb ischaemia on examination, for example, ulceration or gangrene.
• Absent or diminished femoral, popliteal, or foot pulses on clinical examination.
• Failure to improve symptoms after supervised exercise programmes and optimisation of medical management in patients with lifestyle-limiting intermittent claudication.
• Imaging confirming suitability for revascularisation procedures such as angioplasty or bypass surgery.
• Severe lifestyle-limiting intermittent claudication unresponsive to angioplasty or when angioplasty is unsuitable.
• Critical limb ischaemia requiring revascularisation, assessed by a vascular multidisciplinary team considering comorbidities, disease pattern, vein availability, and patient preference.

Referral should be considered when these signs are present to allow assessment for possible revascularisation or surgical intervention by vascular specialists NICE CG147.