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When to Refer a Patient to a Vascular Surgeon

Vascular surgery is a specialised medical field that focuses on the diagnosis and treatment of disorders affecting the blood vessels, excluding those in the heart and brain. As a general practitioner or other specialist you play a crucial role in identifying patients who may benefit from the expertise of a vascular surgeon.


This information provides guidance on when to consider referring a patient to a vascular surgeon and common conditions/symptoms that warrant such referrals.

When to Refer a Patient to a Vascular Surgeon:

  1. Peripheral Arterial Disease (PAD):

    • Symptomatic PAD with claudication (pain or cramping in the legs while walking).

    • Critical limb ischemia with rest pain, non-healing wounds, or gangrene.

    • Decreased or absent peripheral pulses in the lower extremities.

  2. Aneurysmal Disease:

    • Abdominal aortic aneurysm (AAA).

    • Thoracic aortic aneurysm (TAA) of any size with associated risk factors or symptoms.

    • Popliteal artery aneurysm or aneurysms involving other peripheral arteries.

  3. Carotid Artery Disease:

    • Carotid artery stenosis >50% in patients with transient ischemic attacks (TIAs) or strokes.

    • Asymptomatic carotid artery stenosis >80% in select cases.

  4. Venous Disease:

    • Deep vein thrombosis (DVT) with high risk for complications, such as extensive clot burden or phlegmasia.

    • Chronic venous insufficiency with skin changes, ulcerations, or recurrent cellulitis.

    • Upper extremity DVT, which could be due to venous thoracic outlet syndrome (VTOS).

    • Pelvic congestion syndrome, particularly when common alternative causes have been ruled out by gastroenterology and gynaecology.

  5. Non-healing Wounds of the lower limbs:

    • Chronic, non-healing wounds, especially in patients with associated vascular risk factors.

  6. Varicose Veins:

    • Severe, symptomatic varicose veins causing pain, skin changes, or ulceration.

  7. Acute Limb Ischemia:

    • Sudden onset of severe limb pain, pallor, pulselessness, paresthesia, or paralysis.

  8. Vascular Trauma:

    • Penetrating or blunt vascular injuries, such as gunshot wounds or motor vehicle accidents.

  9. Complex Vascular Access:

    • Patients requiring dialysis access, especially for fistula creation or management.

Common Symptoms/Red Flags:

  • Unexplained leg pain or weakness.

  • Cold, pale, or discolored extremities.

  • Rapidly expanding or pulsatile masses.

  • Bruits over major arteries.

  • Non-healing wounds or ulcers.

  • Sudden-onset severe headache or visual disturbances (suggestive of carotid disease).

  • Swelling, tenderness, or redness of the extremities (suggestive of DVT).


Additional Considerations:

  • Evaluate and manage modifiable risk factors, such as hypertension, diabetes, smoking, and hyperlipidemia, before referral.

  • Coordinate care with the vascular surgeon for urgent cases, such as acute limb ischemia or ruptured aneurysms.

  • Ensure clear communication and thorough medical records transfer to the vascular surgeon for a seamless transition of care.

Referring patients to a vascular surgeon at the appropriate time is essential for the early diagnosis and optimal management of vascular conditions. Timely referrals can significantly improve patient outcomes and prevent potentially life-threatening complications.


Collaboration between general practitioners and vascular surgeons is vital in providing comprehensive care to patients with vascular disorders.

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