General Practitioners - PVD


When assessing patients it is important determine the claudication distance. In general, patients who can walk several hundred meters are better treated conservatively. All patients should have the cardiovascular risk reduced where appropriate with smoking cessation, statins, diabetic control, asprin, and BP control. Over 80% of claudicants remain stable if they can control their risk factors.

Patients with short distance claudication or work limiting claudication should be referred for assessment and possible intervention. It is imperative patients understand that angioplasty / stents / bypass surgery is not a single procedure but require ongoing follow-up and possible re-intervention. Patients who continue to smoke need to understand 4x to 7x increased risk of treatment failure, hence reluctance for intervention in this group.

Critical limb ischaemia

Patient with rest pain (e.g. hanging leg over bed at night) and tissue loss (ulcers, gangrene) should be referred urgently to clinic or admitted acutely through the on call registrar. Majority of these patients give no preceding claudication symptoms. If the history is embolic / sudden in nature then it is imperative prompt admission so patient can be seen to administer heparin and arrange embolectmy / thrombectomy. These patients pose a significant management challenge due to most have multiple co-morbidities which precludes then from major revascularisation surgery.


Generally if patient has palpable foot pulse (either dorsalis pedis or posterior tibial) then the ulcer is unlikely due to macrovascular arterial insufficiency. It is most likely be venous, trauma, neuropathic or malignancy. Patients without palpable foot pulses should be referred for assessment of ABPI and further investigations and management.

Patients that are bed –bound or develop pressure related ulcers are unlikely to benefit from revascularisation. These chronic ulcers should be seen in clinic with patient and family members to discuss options.

Peripheral aneurysms

All femoral, popliteal or peripheral aneurysms should be referred for assessment regardless of size. Peripheral artery aneurysms are rare, except for popliteal, and may represent other pathogenesis rather than simple atherosclerosis.

False aneurysms

All false aneurysms following trauma or angiography should be referred regardless of size or location as these are more likely to cause complications (rupture, embolise, pressure necrosis) than true aneurysms.