Vascular Surgical Problems: From the GP's Clinic to the Specialist's Office — A Complete Guide

Never confuse varicose veins with cellulitis and simply give a course of antibiotics to send the patient away — that is the wrongest possible thing to do, and it is not a constructed scenario. This happens regularly in real-life GP clinics, and any swollen leg deserves at least a Doppler ultrasound before it is written off as a skin infection.

Out of roughly 25 healthcare facilitators sending referrals, only one or two send a report in a structured format. A recent case arrived with mismatched patient names, ages and even genders across different files for what turned out to be the same patient — a PDF here, a broken image file there, no consolidated record. I would rather give no advice than wrong advice built on poorly collated information.

Absolutely, yes — particularly if the D-dimer is done after the acute phase, in a subacute presentation of a few days. Despite the test's high sensitivity, the result can come back in the low hundreds, nowhere near diagnostic. DVT is an anatomical problem, and for an anatomical problem the answer is to see it directly on ultrasound, not infer it from a blood marker. Vascular ultrasound is learnable within three to four months, and we train nearly all our trainees to do it routinely.

Laser ablation for superficial spider veins or one or two perforators has an excellent prognosis, and works well up to the perforator level. But if the saphenofemoral junction itself is regurgitant, open surgery to ligate the SFJ and clip the draining tributaries is usually the better option rather than relying on endovascular ablation alone.

In a fragile patient, angioplasty is best avoided below the knee — it gives reasonable short-term results but nothing very promising long-term. If intervention is genuinely needed, it is more often approached surgically, favouring a reverse femoro-tibial bypass using the patient's own saphenous vein over a prosthetic graft, and favouring open surgery over an endovascular approach in this territory. Below the knee: use the simpler, older, better-proven option, and know when not to intervene at all.

Peripheral arterial disease and aneurysms on the arterial side, and varicose veins, deep vein thrombosis and pulmonary embolism on the venous side, along with when each does and does not require specialist intervention.

The story starts with the image, not the biochemistry panel. A CT angiogram or equivalent imaging carries far more diagnostic weight in a vascular referral than blood values such as sodium, potassium or cholesterol.

It covers why D-dimer is no longer a reliable first-line test for DVT, and sets out the anticoagulation choices used for both DVT and pulmonary embolism.