From the Guidelines
The most effective treatment for PAOD non-healing wounds involves a comprehensive approach that addresses both the underlying vascular insufficiency and the wound itself, with revascularization and wound care being crucial components, as recommended by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1.
Key Components of Treatment
- Vascular assessment through ankle-brachial index (ABI) testing and possibly angiography to determine the need for revascularization procedures
- Revascularization in a manner that achieves inline blood flow or maximizes perfusion to the wound bed, as beneficial for patients with CLTI and nonhealing wounds or gangrene 1
- Regular debridement of necrotic tissue and appropriate dressings to maintain a moist wound environment
- Infection control with topical antimicrobials or systemic antibiotics if signs of infection are present
- Pressure offloading using specialized footwear or total contact casting, particularly for foot wounds
- Adjunctive therapies like negative pressure wound therapy to accelerate healing by removing excess fluid and promoting granulation tissue
Importance of Multidisciplinary Care
- A multidisciplinary team approach is essential for the management of PAOD non-healing wounds, including expertise in vascular surgery, endovascular interventions, wound care, and infectious disease management 1
- The team should work together to develop a comprehensive care plan that addresses the patient's individual needs and promotes optimal wound healing and limb salvage
Recent Guidelines and Recommendations
- The 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline recommends revascularization in a manner that achieves inline blood flow or maximizes perfusion to the wound bed for patients with CLTI and nonhealing wounds or gangrene 1
- The 2016 IWGDF guidance on the diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers in diabetes emphasizes the importance of evaluating the entire lower extremity arterial circulation and restoring direct flow to at least one of the foot arteries 1
From the Research
Treatment Options for Non-Healing Wounds in Patients with Peripheral Arterial Disease (PAD)
- Revascularization is a common treatment approach for patients with PAD and non-healing wounds, as it aims to restore blood flow to the affected area 2, 3, 4.
- A conservative approach to treatment may be suitable for selected patients with PAD and non-healing wounds, with studies showing that this approach can be successful in over two-thirds of patients 2.
- Bioengineering strategies, such as the use of biomaterials and hydrogels, are being investigated as potential treatments for PAD, with the goal of inducing angiogenesis and promoting wound healing 5.
- Open surgical therapy is still a viable option for some patients with PAD, particularly those with complex lesions or who are not suitable for endovascular treatment 6.
Factors Influencing Wound Healing in Patients with PAD
- Ankle-brachial index (ABI) and transcutaneous oxygen measurement (TcpO2) are important factors in determining the suitability of conservative treatment for patients with PAD and non-healing wounds 2.
- Revascularization, either through endovascular therapy or bypass surgery, can improve wound healing rates and reduce wound healing time in patients with PAD 4.
- The presence of PAD can significantly impact wound healing, with studies showing that wound healing rates are lower and wound healing times are longer in patients with PAD compared to those without PAD 4.
Treatment Outcomes for Patients with PAD and Non-Healing Wounds
- Studies have shown that conservative management of non-healing wounds in patients with PAD can be successful, with complete wound healing achieved in 67% of patients in one study 2.
- Revascularization, either through endovascular therapy or bypass surgery, can improve wound healing outcomes, with one study showing that bypass surgery had a higher wound healing rate and shorter wound healing time compared to endovascular therapy 4.
- Mortality and amputation rates are important considerations in the treatment of patients with PAD and non-healing wounds, with studies showing that conservative management does not increase these risks 2.