Vascular Surgery Referrals

Find assessment and management information on Vascular Surgery conditions at:

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the Emergency Department or seek emergent advice if in a remote area.

  • Haemorrhage 
  • Acute dissection
  • Acute mesenteric ischaemia
  • Acute ischaemic limb
  • Ruptured abdominal aneurysm
  • Vascular trauma
  • Changes in circulation after major joint dislocations / injury
  • Acute arterial occlusion (thrombotic / embolic)
  • Tender aortic aneurysm
  • Referrals for Diabetic foot ulcer should be directed to Multidisciplinary Foot Ulcer service.
  • Referrals for Complex Wounds should be directed to RPH Wound Nurse Practitioner.
  • Referrals for Renal Vascular Access should be directed to RPH Renal Nurse Practitioner.
  • TIAs and proven carotid disease should be directed to RPH Neurology.
  • RPH is an Adult service, Referrals for child and adolescent health services should be directed to Perth Children’s Hospital

To arrange an urgent review or advice, please phone the RPH switchboard on 9224 2244 and ask to speak with the on-call registrar for the relevant speciality.

After verbal clinical handover and agreement with the registrar that the patient requires an appointment with RPH within 7 days please email the patient’s referral to:

RPH, Central Referral Receipting RPH.OutpatientReferrals@health.wa.gov.au

Ensure the referral is:

  • marked IMMEDIATE
  • the name of the registrar or consultant spoken with is written on the referral
  • all essential referral information, investigations, clinical photos are included

IMMEDIATE (Appointment within 7 days):

  1. Diabetesinduced ischaemia
  2. Active infection in leg with peripheral vascular disease
  3. Progressive long saphenous vein thrombosis
  4. Painful leg with ulceration or ischaemic necrosis
  5. Cellulitis in a diabetic or ischaemic leg

Extensive DVT (SVC, brachiocepohalic and subclavian veins, IVC, iliofemoral veins, upper or lower limbs are symptomatic)

Vascular Surgery manages the following conditions. Referrals are triaged based on clinical priority following these guidelines

CATEGORY 1 (Appointment WITHIN 30 DAYS)

  1. Aortic aneurysm Not tender but >4.5 cm or – rapid increase in size (>5mm/6months)
  2. Symptomatic stenosis of internal carotid >70%
  3. Ischaemic rest pain
  4. Diabetic ulcer or neuropathic ulcer
  5. Sequelae of trauma
  6. Haemorrhage from varicose veins
  7. Pre-ulcerative venous disease
  8. Established False aneurysm
  9. Established traumatic arteriovenous fistula

CATEGORY 2 (Appointment WITHIN 90 DAYS)

  1. Arteritis
  2. Aortic aneurysm stable and less than 4.5cm
  3. Claudication (> 100m)
  4. Severe claudication (< 100m)
  5. Post thrombotic limb
  6. Superficial thrombophlebitis
  7. Arteriovenous malformations
  8. Sympathetic dystrophy
  9. Vasospastic disorders
  10. Arterio venous access surgery
  11. Small vessel diseases associated with systemic illnesses (unless tissue loss)
  12. Asymptomatic Carotid artery stenosis
  13. Complications of fistulas including stenosis, obstruction and thrombosis
  14. Non-healing ulcers and wounds varicose vein and venous ulcer scale
  15. Thoracic outlet syndrome
  16. Peripheral vascular disease (other)
  17. Small (<4cm) Thoracic, Abdominal and Peripheral Aortic Aneurysms
  18. Chronic swelling of limb
  19. Varicose veins causing discomfort or associated skin change or bleeding or swelling (CEAP > 3: Ankle oedema of venous origin , not foot oedema) varicose vein and venous ulcer scale
  20. Lymphatic disease

CATEGORY 3 (Appointment WITHIN 365 DAYS)

1. Hyperhidrosis (excessive sweating)

Specialist Clinics/Services include:

  • Multidisciplinary Foot Ulcer Add MFU service to internet and link
  • Wound Nurse Practitioner service
  • Renal Vascular Access Nurse Practitioner service

Referrals will be returned without this.

  • Age, Non-Smoker, BMI  < 30Kg/m2
  • Symptomatic varicose vein, consider conservative therapy such as compression therapy. Where a referral to RPH is still required, please include detailed description of the signs and symptoms of venous severity and documentation of conservative management trialled to date. Refer to the varicose vein and venous ulcer scale (external link) for more information.

Please include photographs with your referral where possible, especially for wounds

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the referral.

Minimum Standard Referral is included in the standard referral template. Please ensure you fullfil the Central Referral Service referral requirements when filing out the referral.

Please ensure patient email and mobile phone numbers are included to facilitate patient contact

Patients can be flagged for Video or Telephone consultations at referral, triage or follow-up.

Please Note: Vascular Surgery has an extensive outpatient waitlist for routine referrals. Consider alternate referral pathways such as:

Named referrals for Vascular Surgery will be allocated a suitably qualified specialist to see the patient, noting these referrals are booked based on first on, first off principles from the outpatient waitlist.

The following are not routinely provided in a public Vascular Surgery service.

  1. Asymptomatic varicose veins – refer to the varicose vein and venous ulcer scale (external link) for more information
  2. Referrals for lymphoedema requiring stockings only
  3. Claudication > 100 meters
  4. Small Abdominal Aortic Aneurysm (<4 cm)
  5. Paediatric patients < 16 years

While the WA Health Excluded Procedures precludes procedures performed for cosmetic or other non-medical reasons, procedures which meet an identified clinical need to improve the health of the patient may be undertaken in public hospitals.

To avoid patients unnecessarily waiting for and attending appointments in cases where surgery cannot be offered at Royal Perth Hospital, referral criteria have been established for abdominal lipectomy, breast reduction, blepharoplasty, male circumcision, rhinoplasty and varicose veins.

Visit the referral criteria for each of the six WA Health excluded procedures page for more information.

The following are not routinely provided in a public service.

  • Plastics – Abdominal lipectomy & Breast reduction
  • Ophthalmology - Blepharoplasty
  • Ear, Nose & Throat (ENT) - Rhinoplasty
  • Urology – Male Circumcision
  • Vascular – Varicose Veins

EMHS is responsible for providing public health services to the people who reside within its boundaries.

The catchment map (PDF 400KB) outlines the suburb catchment areas for East Metropolitan Health Service (EMHS). The country areas that flow to EMHS are Kimberley, Pilbara and Wheatbelt.

Referral to a hospital for assessment and/or treatment is based around multiple criteria. These include:

  • Place of residence – most hospitals have catchments to help service people closer to home. For country patients, the residence of family with whom they will reside whilst attending appointments can be taken into consideration.
  • Age – RPH is an Adult Hospital, children are only treated by some hospitals.
  • Hospital location of specialty services – some conditions need designated specialist services that are not available at all hospitals.

Please use this information to guide referrals to the hospital servicing your patient's residence, and inform your patients of these criteria when you are referring them for public hospital services via the Central Referral Service (CRS).

Last Updated: 12/01/2023