Frequency of Vascular Assessment in Patients with Non-Healing Foot Wounds
MetadataShow full item record
BACKGROUND: Lower extremity wounds can be a significant source of morbidity and mortality. Assessment of lower extremity perfusion is recommended for non-healing ulcers. Our study aims to evaluate management strategies for foot wounds at a large tertiary hospital. METHODS: The retrospective cohort included all patients seen in the Parkland ASC Foot Wound clinic from 2/1/2014 to 6/31/2014. Charts were reviewed to collect demographic characteristics, wound characteristics, type of vascular assessment and wound outcomes. PAD was defined as an ABI <0.9 and non-compressible disease (NCD) as ABI >1.4. Wounds were characterized as non-healing if there was no evidence of improvement after 3 months of follow up. Statistical analysis was then performed on patients with non-healing wounds and no previous history of peripheral vascular disease. RESULTS: The population of 438 patients was 70% male with a median age of 56 and median BMI of 30. The majority of patients were Hispanic (45%) with Caucasian and African-American each representing 25%. Patients had diabetes (87%), hypertension (82%), hyperlipidemia (59%), known CAD (19%), known PVD (36%), previous CVA (6%), CKD (25%), and tobacco use (51%). An ABI was performed in 42% of the cohort (either within 2 years or up to 3 months after the visit). After excluding patients with a known history of PVD, an ABI was performed in 27 patients (27%) with non-healing wounds. Those patients undergoing ABIs were older (56 vs 50, p=0.006), had lower BMI (30 vs 34, p=0.04) and higher prevalence of CKD (40% vs 15%, p=0.007). After adjusting for common risk factors both age and CKD were remained statistically significant (p=0.004 and p=0.001, respectively). Among the ABIs performed, 4 (15%) were found to have PAD, 13 (48%) were normal and 10 (37%) had non-compressible disease. Patients with CAD were also more likely to undergo peripheral angiography with intervention compared to patients with (50% vs 7%, p=0.02) and remained statistically significant after adjusting for traditional risk factors (p=0.001) DISCUSSION: Although strongly recommended in all patients, an ABI measurement was performed in <50% of patients with a lower extremity wound or ulcer. Although the foot wound population has a high rate of vascular risk factors, a vascular assessment was performed in the minority of patients. Patients who underwent vascular assessment and were found to have evidence of ischemia were more likely to undergo subsequent revascularization.
The 55th Annual Medical Student Research Forum at UT Southwestern Medical Center (Monday, January 17, 2017, 2-5 p.m., D1.600)
SubjectClinical Research and Case Reports
Wounds and Injuries
Bhattatiry, M., Koshy, T., & Kumbhani, D. J. (2017, January, 17). Frequency of vascular assessment in patients with non-healing foot wounds. Poster session presented at the 55th Annual Medical Student Research Forum, Dallas, TX. Retrieved from https://hdl.handle.net/2152.5/4001