ABSTRACT
With peripheral vascular disease (PVD), remember: life before limb before length
Life: Patients with claudication are at increased risk of myocardial infarction, cerebrovascular accident and death. Once PVD is diagnosed, secondary cardiovascular prevention is required.
Limb: Those at risk of limb loss have absent pulses with either rest pain or tissue loss. Rest pain is felt in the distal foot or toes (not the calf), initially occurs at night, and ultimately becomes constant. Tissue loss includes necrosis, gangrene or ulcers. Both these groups need urgent referral to the vascular clinic.
Length: There is no agreed ‘walking distance’ at which patients should be referred. Consider in terms of social requirements (jobs and hobbies). Check, too, if walking is also limited by cardiorespiratory or neurological disease, in which case, no benefit will be gained by treating the leg. Note that if a patient has claudication, rest pain or tissue loss, the decision to refer is based on the clinical situation, not the ankle–brachial pressure index (ABPI).
