Vascular Evaluation – Arterial Insufficiency

Many wounds seen by wound care specialists can be ascribed a vascular etiology, including arterial, venous, and diabetic wounds. In order to successfully manage wounds of this type, the underlying vascular dysfunction must first be addressed.

A number of tests and measures are available for detecting arterial insufficiency, the simplest of which is an assessment of the peripheral pulses in both extremities. The absence of a palpable pulse should be followed-up with more sensitive testing, including the use of Doppler ultrasound. This involves a handheld probe that produces an audible signal over moving fluid and gives a subjective test of arterial insufficiency.

The most popular method for the testing of arterial dysfunction is the ankle-brachial index (ABI), which provides a ratio of the systolic BP of the lower extremities to that of the upper extremities. The ABI is a reliable, noninvasive method for measuring peripheral tissue perfusion and presence of peripheral arterial disease and a good indicator of healing potential.

As an extension of the standard ABI, segmental pressure measurements help localize areas of decreased arterial blood flow and are suitable for identifying distal arterial occlusions or stenosis. Furthermore, plethysmography measures volume changes via cuff to assess regional blood flow while duplex scanning combines a Doppler probe with a scanner to offer data relating to blood flow, velocity, and turbulence.

Another method of assessing arterial sufficiency is capillary refill, a reliable indicator of surface arterial blood flow, in which patients exhibiting arterial insufficiency show delayed capillary refill. Venous filling time is also a good predictor for arterial insufficiency

Transcutaneous oxygen monitoring TcOM or TcPO₂ uses series of electrodes adjacent to wound to assess the severity of peripheral vascular disease to assess levels of hypoxia. Wounds with periwound tissue oxygen tension levels <30 mmHg are unlikely to heal without surgical intervention.

If surgical revascularization is being considered, arteriography is often performed in which a radiopaque dye is injected into an artery to visualize blood flow. However, this technique does not form part of a standard wound assessment.

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References

1. Sussman C and Bates-Jensen B. Wound Care. A collaborative practice manual for health professionals. 3^rd Ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philidelphia, US. 2007.
2. Myers BA. The Wound Care Practitioner. Taken from Wound Management: Principles and Practice 3rd ed. Upper Saddle River, NJ: Pearson; 2012.