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Home | Articles | Referral | Vascular Referrals

Vascular Referrals

Last updated 10th July 2024

Refer Urgently to Hairmyres Vascular On-Call

  1. Acutely ischaemic limbs
  2. Ruptured/Symptomatic Aortic Aneurysms or other Acute Aortic Syndromes including penetrating aortic ulcers/intramural haematoma
  3. All referrals (except those for ascending aorta dissection) should go to the on call vascular registrar who can be contacted through Hairmyres switchboard on 01355 585000

Acute Limb Ischaemia

  1. Undertake urgent CT angiography unless this will incur significant delay
  2. Refer urgently to Hairmyres vascular on-call for advice
  3. If transfer agreed then, blue light ambulance to Hairmyres – Emergency Department.
  4. Prescribe 5000iu unfractioned heparin, providing there are no contraindications. See Unfractionated Heparin Infusion
  5. Ideally, the heparin bolus should be followed with a heparin infusion (see note 4). However, in the event that there is insufficient staff to provide a nurse transfer, the infusion can be withheld until arriving in Hairmyres. Paramedics cannot transfer patients with IV infusions running.

Suspected Aortic Aneurysm/Acute Aortic Syndrome

  1. Immediate CT angiogram of aorta to confirm diagnosis. If likely to incur significant delay then do US in ED and discuss. Please review available documentation (including clinical portal) to help inform discussion with the Hairmyres Vascular Team. Refer to Hairmyres Vascular Registrar who will discuss scan and clinical situation with the Consultant on-call. DO NOT wait for formal report as Hairmyres team will review.
  2. If accepted arrange a blue light ambulance to University Hairmyres Hospital (medical transfer not required in normal circumstance).
  3. If surgical intervention not appropriate (after discussion with Hairmyres Team) follow guidance from Royal College of Emergency Medicine and treat patient on a palliative care pathway.

Aortic Dissection

  1. Admit to CCU under medicine for blood pressure control.
  2. If descending aorta dissection then discuss with Hairmyres.
  3. If ascending aortic dissection then discuss with Golden Jubilee

Acute Diabetic Foot Sepsis

  1. Admit under care of General Surgery for assessment by Surgical Middle Grade.
  2. Click here for more detail and link to The Diabetic Foot

Non Life/Limb Threatening Peripheral Vascular Disease e.g. Chronic Critical Ischaemia Such as Black Toe/Ulceration

  1. Assessed by surgical middle grade surgeon or vascular nurse and if does not require direct transfer to Hairmyres then admit directly under surgery for pain relief and assessment.
  2. If ischaemic pain more than 48 hours refer Hairmyres Vascular on-call. If transfer agreed then transfer to Hairmyres.
  3. If no immediate vascular input required then admit patient under on-call General Surgeons and liaise with Vascular Nurse and Vascular Surgeon. Will be seen by Vascular surgeon in urgent slot at clinic or ward review if available.

Patients Admitted Under Other Specialties with Chronic Critical Ischaemia

  1. Inform Vascular Nurse (via switchboard) or DGRI General Surgery On-call Middle Grade (via switchboard) out of hours to arrange urgent OPD or consultant ward review.
  2. It will then be decided if urgent vascular imaging (CTA or Duplex) is required.

Venous Thrombosis

  1. Patients with venous thrombosis are admitted under Medicine. If extensive venous thrombosis ie proximal to inguinal ligament then discuss with Vascular Registrar on-call in Hairmyers
  2. Venous Ulceration. Phone Vascular Nurse

Carotids

  1. Stroke Team to refer with a phone call to Hairmyres vascular secretarial team.
  2. Contacts details are: Linda Hill 01355 584743; Marion Miller 01355 584789; Karen McConville 01355 584087; Debbie Mowat 01355 585321

GP Referrals to Vascular

  1. Refer directly to DGRI General Surgery on-call.
  2. There is no on-call vascular on DGRI site however calls will be taken by DGRI General Surgeons.
  3. Patients will be discussed with General Surgery on-call in DGRI and a management plan agreed. This will be one of these options:
    • Directed to send patient to DGRI –Surgical Assessment Unit
    • Directed to send patient to Hairmyres – Emergency Department.
    • Patient requires urgent out-patient clinic review by vascular service in DGRI. On-call person will arrange this.
    • Watchful wait following advice.
    • No vascular intervention required. GP to decide if patient needs referred to another speciality.

Temporal Artery Biopsies

  1.  from Rheumatology and Medical Specialties will continue to be sent to Patient Focus Booking at DGRI.
  2. GP referrals to go to Rheumatology for assessment or Opthalmology if visual symptoms.

Groin Abscess

  1. Under care of General Surgery unless vascular involvement. If vascular involvement refer directly to Hairmyres
  2. CT Angiogram – if arterial involvement refer directly to Hairmyres Vascular on-call via Hairmyres switchboard 01355 585000 (24 hours).
  3. No arterial involvement – perform drainage at DGRI during working day (with vascular on site cover if available)

Content by Chris Isles