12 Dec Importance of Vascular Screening and Wound Healing
be aware of the early signs of vascular disease
Nearly 2% of the population in the United States suffers from chronic wounds. One of the major risk factors for impaired wound healing is vascular disease. Peripheral arterial disease (PAD) affects roughly 12-14% of the general population (nearly 8.5 million people over the age of 40); however, this percentage is closer to 20% for those over the age of 75. Given the high burden of vascular disease and the impact on wound healing, it is important for providers to be aware of early signs of vascular disease.
Vascular disease encompasses a wide variety of conditions. When thinking of lower extremity wounds the most abundant etiology for non-healing chronic wounds is venous insufficiency and PAD. Vascular disease occurs when plaque builds up in the arteries causing blood flow to be reduced. Blood carries necessary nutrients to wounds that aid in healing such as oxygen. When this process is interrupted, delayed wound healing occurs and if overlooked it may ultimately lead to unnecessary amputations. The risk of major amputation within 1 year of developing a chronic wound is 50%. Nearly 29% of patients with chronic wounds in the setting of PAD undergo major amputation within the first year which equates to a 5-year mortality rate of 70%. Therefore, screening and early detection for PAD are crucial elements for limb salvage.
risk factors for vascular disease
Risk factors for vascular disease include advanced age (over 65), tobacco use, heart disease, diabetes, chronic kidney disease, high blood pressure, high cholesterol, obesity, and family history of vascular disease. The primary goal of assessment when a patient has a chronic non-healing lower extremity wound, regardless of or risk factors, is to assess blood supply to the wound. The first line test for screening and diagnosis of PAD is to obtain an arterial brachial index (ABI) and/or toe brachial index (TBI). An ABI/TBI is a non-invasive test to help screen and identify PAD. The American Heart Association recommends that any patient with a chronic non-healing wound, diabetes, and/or chronic kidney disease, must have a TBI measurement even if the ABI falls within normal range due to the high risk of having falsely elevated readings. 8% of all ABIs are abnormal and this is likely closer to 20% in patients with wounds due to other co-morbidities. Other modalities of assessment included doppler ultrasounds and doppler waveforms.
a team approach
Chronic, non-healing wounds in the setting of PAD require a team approach to treatment. Multiple specialists including wound care, vascular, endocrinology, primary care, and podiatry are examples of the many providers required to positively impact patient outcomes. Specialized wound care with advanced therapies in collaboration with multiple specialists can increase healing rates while reducing amputations risks and preventing unnecessary amputations. Ultimately, providing improved quality and quantity of life.