Models of same-day emergency care for vascular limb salvage

The efficient and effective management of patients with chronic limb-threatening ischaemia (CLTI) is a challenge for UK vascular services, due to the volume and complexity of patients and centralisation of services.1,2 In an attempt to provide comprehensive limb salvage services in keeping with the global vascular guidelines,3 more than 14,000 revascularisation procedures are performed in the NHS every year.4 Despite our best efforts, outcomes (amputation and mortality) for these patients remain relatively poor, and may be related to delays in revascularisation.5 The recent Vascular Society of Great Britain and Ireland (VSGBI) Peripheral Arterial Disease Quality Improvement Framework (PADQIF) recommends intervention for CLTI within five days for inpatients and 14 days for ambulatory outpatients.6 In an attempt to achieve these targets, certain UK centres have established emergency vascular or “hot” clinics. These one-stop clinics incorporate full clinical assessment of patients with CLTI with consultant review, supported by laboratory and imaging facilities. This facilitates multidisciplinary discussion prior to intervention and may prevent unnecessary hospital admission. The challenges of establishing and managing these “hot” clinics may minimised by the knowledge and experience of those who have already been through this process.