Peripheral Vascular Disease in Primary Care

199 Pages·2016·3.04 MB·English

by  Anita Sharma

Peripheral Vascular Disease in Primary Care

CHRONIC DISEASES IN PRIMARY CARE
Peripheral Vascular
Disease in Primary Care
ANITA SHARMA
MBBS, MD, DRCOG, MFFP
General Practitioner
Oldham
Contributions by
JOANNE WHITMORE
and
ADELE MARIE SCIMONE
Forewords by
MICHAEL TAYLOR
General Practitioner
Heywood, Middleton and Rochdale PCT
DEEPAK BHATNAGAR
Consultant/Senior Lecturer in Diabetes and Metabolism
Royal Oldham Hospital
University of Manchester
Cardiovascular Research Group
and
GAIL RICHARDS
Chief Executive, NHS Oldham
First published 2011 by Radcliffe Publishing
Published 2016 by CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2011 Anita Sharma
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-84619-435-1 (pbk)
Anita Sharma has asserted her right under the Copyright, Designs and Patents Act 1998 to be
identified as the author of this work.
This book contains information obtained from authentic and highly regarded sources. While all
reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the
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other professional’s own judgement, their knowledge of the patient’s medical history, relevant
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administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does
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Typeset by Pindar NZ, Auckland, New Zealand
Contents
Foreword by Michael Taylor vii
Foreword by Deepak Bhatnagar ix
Foreword by Gail Richards xi
Preface xii
About the author xiv
Contributors xv
Acknowledgements xvii
1 Varicose veins 1
2 Deep- vein thrombosis 13
3 Oral contraceptives and deep- vein thrombosis 25
4 Primary care oral anticoagulant management 29
5 Prevention of post- operative venous thromboembolism 37
6 The diabetic foot 41
7 Restless legs syndrome 57
8 Intermittent claudication 67
9 Leg ulcers 75
Adele Marie Scimone
10 Ankle Brachial Pressure Index 99
CONTENTS
11 The management of peripheral arterial disease in primary
care 107
Joanne Whitmore
12 Tackling smoking: role of the GP 123
13 PAD: primary care service framework 135
14 Secondary care referral 139
15 Commissioning services for peripheral vascular disease 147
16 One- stop clinic 155
17 Multiple- choice questions 163
Index 175
vi
Foreword by Michael Taylor
Whether peripheral vascular disease is your passion or simply is recog-
nised as an important component of your daily work, I have not the least
hesitation in recommending this book to you. Peripheral Vascular Disease in
Primary Care lays out in its chapters comprehensive information with the
appropriate amount of detail to satisfy the most ardent general practitioner
(GP) with a special interest in this subject. However, largely written and
completely edited by a GP, Dr Anita Sharma, it has a style that is lean and
sparse while nonetheless remaining a pleasure for any busy professional
to read.
It is a book to relish rather than devour in that it lends itself to reading
one or a few chapters at a time rather than cover to cover in a single sitting.
It is therefore an excellent source and reference book for all primary care
professionals. This attribute is enhanced by the fact that the author has
had the opportunity to consult widely, including specialist colleagues, both
doctors and nurses.
Having had the privilege and pleasure of contributing to the learning of
students, nurses and registrars I am well aware of the suitability of this book
for their purposes. They will be surprised with the descriptions of various
pathologies simply explained, which they will seldom have noticed while
working on hospital wards.
As it goes to press this book is completely up to date and is unlikely to
need revision for many years. Chapter 15, on commissioning services for
peripheral vascular disease, is particularly timely as the National Health
Service enters a period of austerity and GP commissioning.
vii
FOREWORD BY MICHAEL TAYLOR
To summarise, this is a pragmatic book written by a GP and her team
for GP teams; it should, therefore, fi nd a place on the bookshelves of busy
practices.
Dr Michael Taylor BSc, MB, ChB, MRCGP MICGP
General Practitioner
Heywood, Middleton and Rochdale PCT
January 2011
viii
Foreword by Deepak Bhatnagar
Clinical professionals generally do not perceive the peripheral vasculature
as an important site of disease as compared with the organs in the major
cavities of the body. Neglected in this way, pathology in the peripheral vas-
cular system often presents clinically in an advanced stage or in a dramatic,
life- threatening manner. It is, therefore, important that symptoms and signs
of disease are recognised early.
Peripheral vascular disease is thought to be more prevalent in the older
age group, but it is important to appreciate that it can occur prematurely
in certain high-r isk groups such as people with diabetes or lipid disorders.
As with most conditions lifestyle-r elated factors such as diet, smoking and
obesity often play a major role in the causation of disease in the peripheral
vasculature. This book offers the reader a very useful overview of peripheral
vascular disease as well as suggesting models of care.
Those working in primary care need to be able to recognise not only the
acute presentations of peripheral vascular disease – such as critical limb isch-
aemia or deep-v ein thrombosis – but also manage the preventative aspects
and routine treatment of conditions such as varicose veins, intermittent
claudication, leg ulcers and the diabetic foot. If managed poorly peripheral
vascular disease can lead to problems with tissue viability. The good news
is that the framework for diagnosing and managing many of these condi-
tions in the community is gradually being put in place. This should avoid
unnecessary admissions to hospital, but it is important that any manage-
ment strategy is integrated with secondary care so that the patient pathway
is seamless, with easy and timely access to any level of care.
ix