Early ABI Testing May Decrease Risk of Amputation for Patients With Lower Extremity Ulcers - PubMed (original) (raw)

Early ABI Testing May Decrease Risk of Amputation for Patients With Lower Extremity Ulcers

Angela Aguirre et al. Ann Vasc Surg. 2022 Feb.

Abstract

Background: Patients with lower extremity wounds from diabetes mellitus or peripheral artery disease (PAD) have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine if the early assessment of arterial perfusion correlates with the risk of amputation.

Methods: We retrospectively reviewed patients referred to the vascular clinic over 18 months with Rutherford Grade 5 and 6 chronic limb-threatening ischemia to determine if patients had a pulse exam done at the time the wound was identified and when ankle brachial index (ABI) testing to evaluate perfusion was performed. Kaplan Meier analysis was used to determine if the timing of ABI testing affected the time to revascularization, wound healing, and risk of amputation.

Results: Ninety-three patients with lower extremity wounds were identified. Of these, 59 patients (63%) did not have a pulse exam performed by their primary care provider when the wound was identified. Patients were classified by when they underwent ankle brachial index testing to assess arterial perfusion. Twenty-four had early ABI (<30 days) testing, with the remaining 69 patients having late ABI testing. Patients in the early ABI group were more likely to have a pulse exam done by their PCP than those in the late group, 12 (50%) vs. 22 (32%), P = 0.03. Early ABI patients had a quicker time to vascular referral (13 days vs. 91 days, P < 0.001). Early ABI patients also had quicker times to wound healing than those in the late group (117 days vs. 287 days, P < 0.001). Finally, patients that underwent early ABI were less likely to require amputation (Fig. 1), although this did not reach statistical significance (P = 0.07).

Conclusions: Early ABI testing expedites specialty referral and time to revascularization. It can decrease the time to wound healing. Larger cohort studies are needed to determine the overall effect of early ABI testing to decrease amputation rates.

Keywords: ABI; Ankle brachial index; CLI; CLTI; PAD; Peripheral artery disease; chronic limb-threatening ischemia; critical limb ischemia.

Copyright © 2021 Elsevier Inc. All rights reserved.

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Figures

Fig. 1.

Fig. 1.

Risk of an amputation based on early versus last ankle brachial index measurement.

References

    1. Humphries MD, Brunson A, Li C-S, et al. Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data. J Vasc Surg 2016;64:1747–1755.e3. -PMC -PubMed
    1. Curry SJ, Krist AH, et al. , US Preventive Services Task Force Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index: US preventive services task force recommendation statement. JAMA 2018;10:177–83. -PubMed
    1. Association AD. 4. comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes—2020. Diabetes Care 2020;43:S37–47 Supplement 1. -PubMed
    1. Gerhard-Herman Marie D, Gornik Heather L, Barrett Coletta, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation 2017;135:e686–725. -PMC -PubMed
    1. Schaper NC, Netten JJ, van Apelqvist J, Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev 2020;36(S1):e3266. -PubMed

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