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Vascular Surgery - public patients 

Please note that this service has reopened and is now accepting referrals.

Purpose

This page contains information for general practitioners on how to refer patients aged 16 years and over to Vascular Surgery services at Mater Hospital Brisbane.

Scope of Service

This service includes referrals for carotid artery disease, lower limb ulceration (including severe peripheral arterial, venous and diabetic foot ulceration), venous access (including haemodialysis access procedures), lymphoedema.

It is beyond the scope of practice currenty to manage elective aortic aneurysm disease that is likely to require endovascular aneurysm repair (EVAR).

Peripheral arterial disease that is causing claudication is likely to be managed with risk factor modification rather than arterial intervention.

Varicose veins that are not associated with significant complications remain beyond scope also.

Referral Criteria

Please include all of the minimum referral requirements and:

See Pre-Referral Guidelines below for suggested work-up by condition and information required for appropriate triaging.

Mater Adult Referral Form

Referrals can be faxed to 07 3163 8548.

Referral Categorisation

Available appointments are provided to our patients based on clinical priority

Examples only (not a complete list of referrals accepted).

This should be used as a general guideline only – categorisation will be based on the individual referral.

PRIORITY SEMI-URGENT ROUTINE

-  Diabetic foot infection

-  PVD with rest pain or ulceration

-  Carotid disease with unilateral symptoms

-  High grade (>80%) asymptomatic carotid disease

-  Chronic non-arterial leg ulceration

-  Lymphoedema

-  Arterial claudication

-  Swollen legs

Mater endeavours to see all priority patients within 30 days from GP referral

Mater endeavours to see all semi urgent patients within 3 months from GP referral

Mater endeavours to see all routine referrals within 12 months from GP referral

 

Our Specialists

Dr John Bingley Vascular Surgeon
Dr Peter Bryant Vascular Surgeon

 

Bulk Billed Clinics

Mater Health Services offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed specialist clinic, please provide a named referral to one of our specialists listed above.

Contact Us

If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200 

Pre-Referral Guidelines

 

Varicose Veins

The following guideline is intended for consideration by the treating GP.  It is subject to the assessment of the patient’s clinical circumstances and in no way is intended to replace the clinical assessment and judgment of the GP.

Suggested workup

Duplex of superficial and deep leg veins

Recommended pre-referral treatment

Lifestyle Changes:

  • Weight loss if BMI >35

Medical Management:

  • Compression class 1 knee high stockings
When to refer
Due to current Queensland Health criteria for treatment, referrals will be declined unless there are associated complications such as condition will be funded for public hospital operation unless there are associated complications such as varicose ulcers (active or healed), skin changes of venous hypertension, superficial thrombophlebitis or recurrent bleeding.
What to Include
  • Initial work-up results and information.

 

Swollen Legs and Lymphodema

The following guideline is intended for consideration by the treating GP.  It is subject to the assessment of the patient’s clinical circumstances and in no way is intended to replace the clinical assessment and judgment of the GP.

Suggested workup

Duplex deep and superficial veins

FBC

ELFT

Recommended pre-referral treatment

Lifestyle Changes:

  • Weight loss if BMI >35
  • Avoid sedentary position for long periods (actively walk, or elevate legs to level of heart)

Medical Management:

  • Simple skin care (skin moisturiser and hygiene; avoid UV exposure)
When to refer

If clinician feels it is likely to be lymphedema or deep venous insufficiency.

What to include
  • Initial work-up results and information.

 

Leg Ulcers

The following guideline is intended for consideration by the treating GP.  It is subject to the assessment of the patient’s clinical circumstances and in no way is intended to replace the clinical assessment and judgment of the GP.

Suggested workup

Duplex arterial and ABI if pulses absent

Duplex venous if varicose veins or likely venous aetiology

Recommended pre-referral treatment

Lifestyle Changes:

  • Weight loss (aim BMI<35)
  • Smoking cessation
  • Avoid sedentary position for long periods (actively walk, or elevate legs to level of heart)

Medical Management:

  • Analgesia
  • Simple wound care
  • Surgical compression stockings
When to refer

Red flags: ischaemic rest pain, gangrene, malodourous ulceration, sepsis

What to include
  • List of all current medications
  • Record of previous cardiac and other vascular treatments
  • Recent cardiac tests, including stress test results
  • Recent pathology results (FBC, ELFTs)
  • Advanced health directive (where extant)

 

Carotid Disease

The following guideline is intended for consideration by the treating GP.  It is subject to the assessment of the patient’s clinical circumstances and in no way is intended to replace the clinical assessment and judgment of the GP.

Please note: Symptomatic carotid arterial disease (uni-lateral central neurological and retinal change) deserves to be seen as a matter of high priority

Suggested Workup

Arterial duplex Carotids

CT brain if incomplete recovery from CVA

FBC, ELFT, Coagulation profile

Recommended pre-referral treatment

Lifestyle Changes:

  • Smoking cessation

Medical Management:

  • Commence Anti-platelet agent (aspirin)
  • Review Atherosclerosis risk factors: Hypertension, Diabetes, dyslipidaemia
  • Consider active cholesterol and blood pressure lowering
When to refer

Red flags: immediate referral (including to emergency department) for new CVA, TIA, amaurosis fugax, or crescendo episodes.

What to include
  • List of all current medications
  • Record of previous cardiac and other vascular treatments
  • Recent pathology results (FBC, ELFTs)
  • Recent cardiac tests, including stress test results
  • Advanced health directive (where extant)

 

Aortic Aneurysm

The following guideline is intended for consideration by the treating GP.  It is subject to the assessment of the patient’s clinical circumstances and in no way is intended to replace the clinical assessment and judgment of the GP.

Please note: EVAR is not currently available for public patients at Mater, and referral for AAA may be declined for this reason.

Suggested workup

Imaging of Aorto-Iliac system (Arterial Duplex, or CT scan with IV contrast if maximum diameter > 4.9cm).

Cardiac stress testing if AAA >4.9cm, and operation a realistic possibility for this patient

FBC, ELFT, Coagulation profile.

Recommended pre-referral treatment

Lifestyle Changes:

  • Weight loss
  • Smoking cessation

Medical Management:

  • Review Atherosclerosis risk factors: Hypertension, Diabetes, dyslipidaemia
  • Commence anti-platelet agent
  • Consider active cholesterol and blood pressure lowering
When to refer

Red flags: AAA maximum diameter >5.0cm; new tenderness of AAA; cardiovascular instability associated with new onset abdominal pain in presence of known AAA (immediate referral to Emergency Department).

What to include
  • List of all current medications
  • Record of previous cardiac and other vascular treatments
  • Recent pathology results (FBC, ELFTs)
  • Recent cardiac tests, including stress test results
  • Advanced health directive (where extant)

 

Peripheral Arterial Disease (PAD)

The following guideline is intended for consideration by the treating GP.  It is subject to the assessment of the patient’s clinical circumstances and in no way is intended to replace the clinical assessment and judgment of the GP.

Please note: A full suite of PTA is not currenlty available for public patients at Mater, and referral may be declined for this reason.

Suggested Workup

For asymptomatic patients and patients with long distance claudication, no specific imaging is required. These patients do not require review by a vascular surgeon and do not require intervention beyond atherosclerosis risk factor modification.

For patients with short-distance claudication, rest pain or ulceration, duplex arterial studies of affected limbs, (including aorto-iliac components).

Cardiac stress testing if rest pain or ulceration, and operation a realistic possibility for this patient

FBC, ELFT, Coagulation profile.

Recommended pre-referral treatment

Lifestyle Changes:

  • Weight loss
  • Smoking cessation
  • Encourage daily walking

Medical Management:

  • Review Atherosclerosis risk factors: Hypertension, Diabetes, dyslipidaemia
  • Commence anti-platelet agent
  • Consider active cholesterol and blood pressure lowering
When to refer

Red flags: ischaemic rest pain, ulceration or tissue loss, wet gangrene.

What to include
 
  • List of all current medications
  • Record of previous cardiac and other vascular treatments
  • Recent pathology results (FBC, ELFTs)
  • Recent cardiac tests, including stress test results
  • Advanced health directive (where extant)

 Content reviewed 26/08/2016

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