When should I consider referring a patient with a leg ulcer for specialist vascular assessment?

Consider referring a patient with a leg ulcer for specialist vascular assessment if:

• The leg ulcer is venous in origin and has not healed within 2 weeks despite appropriate treatment.
• There are signs of symptomatic primary or recurrent varicose veins associated with troublesome lower limb symptoms such as pain, swelling, or skin changes.
• There are lower-limb skin changes like pigmentation or eczema thought to be caused by chronic venous insufficiency.
• There is superficial vein thrombosis with suspected venous incompetence.
• The patient has a healed venous leg ulcer requiring ongoing assessment.

Referral to a vascular service is important because such services provide full clinical and duplex ultrasound assessment and a range of treatment options tailored to the patient's condition.

Immediate referral is warranted if there is bleeding from varicose veins.

For diabetic foot ulcers, specialist assessment is also indicated to evaluate size, depth, infection, ischaemia, and to guide multidisciplinary management, but this is a separate pathway.

In summary, any venous leg ulcer not healing within 2 weeks, or associated with the above venous symptoms or complications, should prompt referral for specialist vascular assessment.

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