Objectives: Peripheral arterial disease (PAD) can reduce wound healing up to 30%. Data from academic hospital-associated wound care centers suggest improvements in wound healing outcomes when wound management is driven by vascular providers. However, whether this benefit is derived solely from early vascular provider involvement remains unclear.
Methods: A retrospective analysis of 80 patients with arterial disease seen at our institution’s wound center between 7/2022-7/2023 was performed. Presence of disease was defined by more or one of the following: (1) prior PAD diagnosis, (2) ankle-brachial-index (ABI) < 0.9 or toe pressure < 70 mmHg, or (3) documented absent lower extremity pulses. Patients were divided into 2 groups: early ( < 6 week) vascular provider exposure (EVE; n=45) or late/no vascular involvement (LVE; n=35). Vascular providers included vascular surgeons and affiliated advanced practitioners. Outcomes were analyzed with chi-square, t-test, Kaplan Meier analysis, and Cox regression modeling (variables included if effect on healing associated with p< 0.1).
Results: Baseline functional status and comorbidity profiles are outlined in Table I. While initial wound sizes were similar, maximum wound size was significantly larger in the EVE group (p=.002*). WIfI wound scores(p=.039*) and gangrene were higher in the EVE group on presentation (p=.05*). Though more patients in the LVE group developed imaging-confirmed osteomyelitis (p=.033*), fewer received debridement/amputation (p=.008*). Wounds in the LVE group also took significantly longer to reach maximum size (p <.001*) or checkpoints predicting closure, including 75% wound granulation (p=.05*), 15% size reduction in 1 week (p=.044*), and epithelialization (p=.026*). More wound center visits (p=.024*) and clinic procedures (p=.005*) were required for LVE despite similar surgical provider visits. Additionally, LVE had longer times to revascularization (p <.001*) or amputation/debridement (p=.002*) and fewer scheduled intervention after their first surgical provider visit (p=.026*). All the patients in EVE had ABIs performed, with 90.9% of them being performed within 30 days from wound appearance (p <.001*). Though more patients underwent a major amputation in the EVE group (15.6%vs11.4%), all had documented non-salvageable limbs prior to amputation. Healing time trended to be shorter in EVE, but this difference failed to attain statistical significance (p=.089). When controlled for comorbidities, however, healing time was significantly accelerated almost two-fold in the EVE group (Table II, p=.032*).
Conclusions: Early vascular exposure improves wound healing time, timeliness to intervention, and use of wound center/hospital resources. Further investigation into benefits of vascular involvement within community wound center models could significantly improve awareness and accessibility of arterial wound care in smaller/remote communities.
