Frequency of Vascular Assessment in Patients with Non-Healing Foot Wounds
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.