Referral to cardiac surgeon from GP

Appointment for preoperative assessment clinic within 24 weeks

Blood tests, X-ray and ECG

CT scan, ultrasound Duplex scan if required

Medical history Venous/arterial assessment Ankle brachial pressure index (ABPI) Surgery

Vascular referral if necessary

Postoperative K-Lite (Urgo Medical) support bandage toe-to-groin on affected leg in spiral application Pneumatic compression therapy

RediVac drain for 48 hours or drainage <30ml in 24 hours

Sedated and ventilated for first 24 hours Full bed rest approximately 48 hours postoperative Passive leg exercises

48 hours postoperative

Support bandaging removed High/reduced compression hosiery or bandaging as per ABPI

RediVac drain removed

Mobilisation Deep breathing Passive exercise

Diuretic therapy Skin care

96 hours postoperative

High/reduced compression hosiery/bandage

Mobilising as tolerated Deep breathing

Diuretic therapy

Leg elevation and exercise on sitting Skin care

Predischarge Day 57 High/reduced compression hosiery/bandage Wear until preoperative exercise level is fully established

Postoperative dressing removed wound exposed

Diuretic therapy

Post discharge exercises and patient education specific to limb oedema

Rehabilitation six-week postoperative appointment

Figure 1 Proposed pathway for patients with venous/arterial disease.