Peripheral Arterial Disease

Emergency department referrals

All urgent cases must be discussed with the on call Vascular Registrar. Contact through Royal Brisbane and Women's Hospital (07) 3646 8111 to obtain appropriate prioritisation and treatment.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Active infection in leg with peripheral arterial disease
Diabetic foot infection (refer to high-risk foot pathway)
Acute arterial ischemia/threatened limb
Ischaemic changes and/or threatened limb (ulcer, gangrene, rest pain)
Diabetic foot with ulcer or infection

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Claudication <50m
Peripheral aneurysm above the treatment threshold
Rest pain, arterial ulceration

Category 2

Appointment within 90 days is desirable

Intermittent claudication with no signs of limb-threatening ischaemia >50m
Asymptomatic peripheral aneurysms below the treatment threshold
Lifestyle limiting claudication

Category 3

Appointment within 365 days is desirable

Asymptomatic upper and/or lower limb arterial disease

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

- Refer to HealthPathways for assessment and management information if available
- Advance health directive (where available)
- Diabetic foot ulcer: High-risk foot clinic (referral via podiatry and access via telehealth available – Statewide Diabetes Clinical Network will provide details)
- Asymptomatic peripheral arterial disease especially tibial artery stenosis or occlusion when the foot is healthy and the symptoms are proximal to the lesions in non-diabetic patients, do not warrant referral and can be managed conservatively with risk factor modification and exercise therapy. Other causes for the more proximal leg pain should be sought.
- Atherosclerosis risk factor management (antihypertensive; diabetes, dyslipidaemia)
- Lifestyle modification (Increased activity, dietary, weight, smoking, alcohol)
- Claudication with no impact on quality of life should be managed conservatively with risk factor control, graduate exercise therapy and anti-platelets

Deadly Feet Program

Deadly Feet is a multi-disciplinary service providing early assessment, risk modification, and specialist intervention for Aboriginal and Torres Strait Islander people at risk of lower limb conditions associated with diabetes and/or peripheral vascular disease. Patients are reviewed by a vascular consultant, a specialist vascular sonographer, and a podiatrist within one 90 minute appointment in the Deadly Feet clinic at Redcliffe Hospital, Caboolture MATSICHS or Galangoor Duwalami Primary Healthcare Service, Hervey Bay.

Deadly Feet offers relaxed referral criteria to support equitable access to health care for Aboriginal and Torres Strait Islander people. Referrals can be made through GP Smart Referrals and no prior pathology or medical imaging are required. Alternatively referrals can be made by contacting the Deadly Feet project team by phone on 07 3647 1500 or at MNVOP@health.qld.gov.au.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History including
- claudication distance
- rest pain
- ischaemic changes
Peripheral pulses: femoral/popliteal/foot
Risk factors particularly smoking and diabetes
Recent cardiac tests, including stress test results
Duplex USS scan results
U&E FBC & coags, BSL Lipid profile

Additional referral information (useful for processing the referral)

HbA1C if diabetic

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use