Peripheral Arterial Disease (PAD) and Its Impact On Wound Care
Peripheral Artery Disease (PAD) is the narrowing of the arteries in the arms, legs, and internal organs. It’s often caused by atherosclerosis which is the buildup of fat and cholesterol – called plaque – in the arteries. This plaque causes the arteries to become partially blocked. The result is a limited blood supply to the tissues, a hindrance to wound healing, which eventually causes tissue death necessitating lower limb amputation.
Symptoms of PAD
PAD patients usually start with mild symptoms or no symptoms at all. 50% of people living with PAD in the US have no symptoms. The typical symptom of PAD starts with pain. However, lack of pain doesn’t rule out the disease as a contributor to poor wound healing. Other symptoms include:
- Muscle cramps in the calf area when walking
- Pain in the limb at rest
- Advanced ulceration or gangrene
- Weak or absent pulses in the legs or feet
- A lower temperature in one leg than the other
- Skin discoloration
PAD and Wound Care
PAD is the third leading cause of cardiovascular-related deaths worldwide and affects up to 12 million people in the US. Slightly more men than women have the disease. This condition is often the first indicator of a chronic disease within the circulatory system and an overlooked cause of poor wound healing. It's especially prevalent in people living with diabetes but rarely diagnosed and treated.
The most severe form of PAD, Critical Limb Ischemia (CLI) affects 2 to 3.4 million people, with the numbers expected to skyrocket to over 4 million by 2030. CLI can cause wounds to heal slowly. This advanced form of PAD can result in ulcers below the knee, or non-healing wounds between toes.
If a wound is infected, PAD can prevent optimum delivery of systemic antibiotics, resulting in polymicrobial infections and severe cases such as osteomyelitis, a bone infection. For this reason, people with PAD often need special care for healing wounds.
According to the Institute of Medicine, nearly half of all US adults have a problem understanding what a doctor tells them. It’s important that podiatrists, vascular surgeons, and other wound care specialists actively engage in early recognition of PAD especially in patients living with diabetes or metabolic syndrome. Such a practice will aid in administering proper wound care and ultimately lower the amputation rate.
Not all PAD patients will develop non-healing wounds. However, certain risk factors can increase the chances of developing severe conditions. These risks include:
- Certain medical conditions such as high cholesterol, high blood pressure, and diabetes – An estimated 1 out of every 3 people with diabetes over 50 years has PAD, making it a primary co-morbidity of diabetes.
- Smoking – According to the American College of Physicians, the most important thing patients can do to prevent or slow down PAD is to avoid tobacco products.
Diagnosing PAD in a patient with a non-healing wound is important. Non-healing wounds are almost always accompanied by redness, swelling, and pain. If left untreated, these sores are at risk for developing an infection that leads to long-term health complications, including lower limb amputation. Diagnostic tests may include basic blood work, biopsy, and non-invasive studies.
In an attempt to promote PAD diagnosis, the US Wound Registry (USWR) launched its “Do The Right Thing” initiative in 2008. This was to encourage arterial screening of all patients living with chronic diseases or non-healing ulcers.
Chronic wounds are often observed in PAD patients who often have distal arterial perfusion for wound healing. If the obstructed arteries can be bypassed or dilated, the wounds usually heal. However, the wound must be addressed surgically and medically along with revascularization.
Patients hospitalized with PAD are at a higher risk of developing complications. Post-operative care should be aimed at preserving blood flow and tissue oxygen perfusion for adequate collagen synthesis, angiogenesis, and to prevent infections.
Amputation Prevention Through Proper Wound Care
A high low limb amputation rate is associated with a profound economic burden. It’s estimated that over $25 billion per year is spent directly on major and minor amputations in CLI patients. Non-healing wounds themselves account for over $3 billion in healthcare-related costs per year. Lowering the amputation rate and decreasing the wound healing time could theoretically lead to reduced healthcare expenses.
Most patients with PAD can prevent lower limb amputation by getting proper wound treatment in the early stages. This can be done through appropriate diagnosis and revascularization. Wound healing in PAD requires complete optimization of the wound environment. Management of wounds is demanding and will require well-versed physicians in wound care.
Wound care treatment is important and involves:
- Proper wound cleansing
- Removal of dead tissue and grafting
- Antimicrobial medicine and topical wound care therapies
- Moisturizing cream for dry and flaking skin
- Compression dressings
While lower limb wound care takes the combined effort of various wound care specialists, the majority of the healing occurs outside the doctor’s office. Some practices such as exercising, good diet, taking medication, avoiding tobacco, and managing underlying conditions can help prevent PAD development or progression.
Leveraging Technology for Advanced Wound Care
By bringing together professionals such as podiatrists, vascular surgeons, and wound care specialists, the Wound Doc is at the forefront of lower-limb amputation prevention among Blacks. The Wound Docs leverages the power of advanced technologies such as Artificial Intelligence and advanced biologics (skin substitutes) to improve wound care outcomes for African Americans.
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