Vascular Consult 🩸
Guide for vascular surgery consultation and referral. Key information to provide, common indications, and referral scripts for NCHDs.
📋 Key Info to Have Ready
- Patient identifiers: full name, date of birth, location and MRN
- Reason for consult and timeline (e.g. onset of limb pain, wound deterioration)
- Past Medical History: vascular history (PVD, diabetes, previous bypass/angioplasty, aneurysms), smoking status
- Medications: antiplatelets, anticoagulants, diabetic medications
- Observations: vitals, limb perfusion (capillary refill, pulses, colour, temperature, sensation)
- Relevant bloods: FBC, U&E, coagulation, HbA1c if diabetic, inflammatory markers if infection suspected
- Imaging: duplex/Doppler if done, CTA/MRA if available, plain X-ray for osteomyelitis
- ABPI if measured (do not delay urgent referral to get ABPI)
- Clinical impression and what you are seeking (e.g. ?acute limb ischaemia, ?infected foot ulcer, ?DVT)
🔎 Investigations to Know
- Limb assessment: pulses (femoral, popliteal, DP, PT), capillary refill, colour, sensation, motor function
- Duplex ultrasound – for DVT, arterial stenosis, aneurysm screening
- ABPI – chronic limb ischaemia; avoid or interpret with caution in diabetics (calcification)
- Bloods – FBC, U&E, coag, CRP; consider lactate if ?acute ischaemia
- Imaging – CTA/MRA for acute ischaemia or pre-op planning; X-ray if ?osteomyelitis under ulcer
📞 Example Script
- Hi, this is [Your Name], the intern from [Team Name]. I'm requesting a vascular consult for a [Age] year-old [M/F] with [e.g. acute onset leg pain / non-healing foot ulcer / suspected DVT].
- They have a background of [PMH – e.g. diabetes, PVD, smoking]. On examination the limb has [e.g. absent DP/PT pulses, cool and pale / ulcer with surrounding cellulitis]. Observations are [stable/unstable].
- We've [got duplex pending / sent bloods / started LMWH if DVT]. We're concerned about [e.g. acute limb ischaemia / infected diabetic foot / need for duplex] and would appreciate your review.
- Let me know if you need any further information or imaging before you see them.
📝 Tips
- Acute limb ischaemia (6 Ps: pain, pallor, pulselessness, paraesthesia, perishing cold, paralysis) is an emergency – refer immediately and document time of onset
- Do not delay referral for ABPI or duplex if clinical picture suggests acute ischaemia
- For diabetic foot ulcers, document wound site, size, depth, surrounding skin, probes-to-bone; offloading and podiatry input help
- Clarify whether the consult is urgent (e.g. acute ischaemia, rapidly spreading infection) or routine