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PERIPHERAL VASCULAR DISEASE (PVD)• Peripheral vascular disease is characterised by claudication: muscle pain in legs or buttocks on exercise.• Refer the patient newly diagnosed with peripheral vascular disease for specialist assessment.Recognise the patient with peripheral vascular disease needing urgent attention:Claudication with any one of:• Pain at rest• Gangrene• Ulceration• Suspected abdominal aortic aneurysm: pulsatile mass in abdomenRefer same day to hospital.peripheral vascular disease: Routine careAssess the patient with peripheral vascular diseaseAssess When to assess NoteSymptoms At diagnosis and every visit •Document the walking distance before onset of claudication.•Ask about chest pain 77 and symptoms of stroke/TIA 76.•Manage symptoms as per symptom pages.BP At diagnosis and every visit If BP ≥ 130/80 73. Aim to treat hypertension to < 130/80 74.Femoral pulses At diagnosis and every visit Refer if weak or absent.Abdomen At diagnosis and every visit If a pulsatile mass felt, refer for assessment for possible aortic aneurysm.Random glucose At diagnosis and yearly Check random finger-prick glucose 70 to interpret result. Check every visit if patient diabetic.Fasting cholesterol and triglycerides At diagnosis if not already done Refer to specialist if total cholesterol ≥ 7.5 or triglycerides ≥ 5.Advise the patient with peripheral vascular disease• Help the patient to manage his/her CVD risk 69.• Walking an hour a day for at least 6 months can increase by 50% the walking distance. Advise patient to pause and rest whenever claudication develops.• If patient is < 55 years (man) or < 65 years (woman), advise the first degree relatives to have CVD risk assessment 68.Treat the patient with peripheral vascular disease• Give simvastatin 10mg daily for life regardless of cholesterol level.• Give aspirin 150mg daily for life if no history of peptic ulcers or dyspepsia. Avoid if under 30 years.Refer if unacceptable symptoms occur despite adherence to advice and drug treatment.79