What is the current practice for managing patients with chronic limb-threatening ischaemia within vascular surgery services? A survey of the United Kingdom vascular surgeons

Introduction

The Vascular Society of Great Britain and Ireland’s (VSGBI) Peripheral Arterial Disease Quality Improvement Framework (PAD QIF) stipulates targets for managing patients with chronic limb-threatening ischaemia (CLTI), however it is unknown if these are achievable. This survey aims to evaluate contemporary practice for managing CLTI within the UK.

Materials and Methods

A questionnaire was developed in conjunction with the VSGBI to survey the management of CLTI and canvass opinions on the PAD QIF. The survey was distributed to all consultant members of the VSGBI and through a targeted social media campaign.

Results

Forty-seven consultant vascular surgeons based at 36 arterial centres across the UK responded (response rate from arterial centres=46%). Only 14.3% of centres provided outpatient consultation within the target of 7 days from referral, with only one centre providing revascularisation within the target of 7 days from consultation. For inpatient management, 31.6% provided surgical, and 23.8% endovascular revascularisation, within the target of 3 days from assessment. Whilst 60% of participants believe the PAD QIF’s 5-day‘admitted care’ pathway is achievable, only 28.6% thought the 14-day ‘non-admitted care’ pathway was feasible. Challenges to meeting these targets include the availability of theatre space and angiography lists, and availability of outpatient appointments for patient assessment.

Conclusions

The opinion of UK vascular surgeons indicates that achieving the targets of the PAD QIF represents a major challenge based upon current services. Adapting existing services with a greater focus on providing an ‘urgent’ model of care may help to potentially overcome these challenges.