Intermittent Claudication Service UHCW

The clinical aim of the nurse-led claudication service is:

• Provide patients with accurate diagnosis
• Explanation of their disease, required lifestyle changes, and provide support to maintain these
• Maximise pain-free walking distance
• Stabilise their claudication and prevent further disease progression (negating hospital admissions for radiological or surgical intervention, and reducing the patients’ individual risk of associated cardiac or cerebrovascular problems)

About the Service

Clinics currently located in City of Coventry Health Centre, Rugby St Cross and Warwick and we are looking to expand this to include George Eliot Hospital and Stratford.

The clinic assesses and treats patients with symptoms of Peripheral Arterial Disease (PAD) :

• Reproducible exertional muscle pain typically affecting the calves/thighs/buttocks
• Pain feels crampy in nature, is worse on walking uphill and is relieved with a short rest of <10 minutes

Once a diagnosis is confirmed the clinic provides:

• Patients Education: risk factor management and assists / supports the patient to make lifestyle changes
• Best Medical Therapy of anti-platelet therapy, preferably Clopidogrel, and statin therapy (secondary prevention)
• Referral to Supervised Exercise Programme (SEP) as per NICE guidelines. Patients can access 24 NHS funded SEP sessions at Atrium Health in Coventry City Centre or at Cardiac Rehabilitation Department at Rugby St Cross

Supervised Exercise Programme is run by both a Vascular Specialist Nurse and a Clinical Exercise Physiologist with exercise being adapted to suit most patients needs

Pre Referral

Please request FBC, U&Es, LFTs, Cholesterol and HbA1C checks prior to referral

The Intermittent Claudication Service is a nurse-led service, consultants will not see claudication referrals without a nurse assessment in the first instance

Referrals sent to a consultant clinic will be redirected to the nurse-led claudication clinic

Exclusions:

The claudication clinic does not see patients with the following critical symptoms:

• Ulcers
• Toe or foot pain reproducible on elevation which is relieved with dependency
• Necrosis
• Gangrene
• Patients ≤30 years old (the Claudication Clinic does not see patients aged ≤30 years old as popliteal entrapment syndrome needs to be excluded by vascular consultants)
• Patients for ABPI measurements alone (please refer directly to the Vascular Laboratory)

Critical Limb Threatening Ischaemia (‘HOT FOOT CLINIC’- URGENT)

 

Urgent referrals ONLY to be referred to Hot Foot Clinic for urgent assessment

Referrals are vetted by the Vascular Nursing team

This clinic is ran at UHCW only

Inclusion criteria:

• Chronic ischaemic night/rest pain (over 2 weeks)
• Active chronic foot ulcer/gangrene/necrosis
• Sudden onset of claudication pain

Exclusions:

The Hot Foot Clinic should not receive referrals for:-

• Suspected Acute Limb Threatening Ischaemia (ALTI)
• Acute infection
• Acute diabetic foot sepsis
• Patients who are systemically unwell
• Cold feet without rest pain or tissue loss
• Absent foot pulses without rest pain or tissue loss
• Swollen feet without rest pain or tissue loss
• Lymphoedema (please see GP Gateway Lymphoedema page – follow link)

Patients who fall under exclusion criteria should be referred to Surgical Assessment Unit SAU

Advice & Guidance can be used for management advice of these excluded conditions