Semin intervent Radiol 2018; 35(05): 399-405
DOI: 10.1055/s-0038-1676362
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Differentiating Lower Extremity Wounds: Arterial, Venous, Neurotrophic

Ava Star
1   Vascular and Interventional Radiology, Olympia, Washington
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2019 (online)

Abstract

Peripheral arterial disease (PAD) is a currently underdiagnosed and underrecognized vascular disease afflicting up to 200 million people worldwide, with at least 1 million of those suffering from critical limb ischemia (CLI). The 5-year mortality after major amputation for CLI (70%) is twice the average 5-year cancer mortality in the United States, and as many as 50% of CLI patients proceed directly to amputation without preceding vascular assessment or revascularization. Each year, twice as many breast augmentations are performed as leg revascularizations. Strong evidence in the literature supports markedly improved outcomes when multidisciplinary care teams across specialties are engaged to evaluate, treat, and manage patients with lower extremity wounds. This article assists the vascular specialist in differentiating the three most common lower extremity wound types.

 
  • References

  • 1 Mani R, Romanelli M, Shukla V. Measurements in Wound Healing: Science and Practice. London: Springer London; 2013
  • 2 Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers 2013; 2013: 1-9
  • 3 Rayner R, Carville K, Keaton J, Prentice J, Santamaria N. Leg ulcers: atypical presentations and associated co-morbidities. Wound Pract Res 2009; 17 (04) 168-185
  • 4 Järbrink K, Ni G, Sönnergren H. , et al. The humanistic and economic burden of chronic wounds: a protocol for a systematic review. Syst Rev 2017; 6 (01) 15
  • 5 Yost ML. The Cost of Amputation in 2014. Lecture at 4th Annual Amputation Prevention Symposium. August 14-16, 2014
  • 6 Peacock JM, Keo HH, Duval S. , et al. The incidence and health economic burden of ischemic amputation in Minnesota, 2005-2008. Prev Chronic Dis 2011; 8 (06) A141
  • 7 MacKenzie EJ, Jones AS, Bosse MJ. , et al. Health-care costs associated with amputation or reconstruction of a limb-threatening injury. J Bone Joint Surg Am 2007; 89 (08) 1685-1692
  • 8 Bell D. Current concepts in vascular assessment of wounds. Pod Today 2018; 31 (08) 26-32
  • 9 Pierpont YN, Dinh TP, Salas RE. , et al. Obesity and surgical wound healing: a current review. ISRN Obes 2014; 2014: 638936
  • 10 Suckow B. Amputation rate and cost of amputation in the United States. Current Data. Lecture at the Amputation Prevention Symposium 2018. August 8, 2018
  • 11 Feinglass J, Pearce WH, Martin GJ. , et al. Postoperative and late survival outcomes after major amputation: findings from the Department of Veterans Affairs National Surgical Quality Improvement Program. Surgery 2001; 130 (01) 21-29
  • 12 United States Cancer Statistics. Data Visualizations. Survival: 5-year Relative Survival, All Types of Cancer, Invasive Cancers Only, United States. Available at: https://gis.cdc.gov/Cancer/USCS/DataViz.html . Accessed August 22, 2018
  • 13 Bryant R, Nix D. Acute and Chronic Wounds: Current Management Concepts. 5th ed. St. Louis, MO: Elsevier; 2016
  • 14 Bunte MC, Shishehbor MH. Angiosome-guided intervention in critical limb ischemia. Interv Cardiol Clin 2017; 6 (02) 271-277
  • 15 McCallum JC, Lane III JS. Angiosome-directed revascularization for critical limb ischemia. Semin Vasc Surg 2014; 27 (01) 32-37
  • 16 Špillerová K, Settembre N, Biancari F, Albäck A, Venermo M. Angiosome targeted PTA is more important in endovascular revascularisation than in surgical revascularisation: analysis of 545 patients with ischaemic tissue lesions. Eur J Vasc Endovasc Surg 2017; 53 (04) 567-575
  • 17 Uzun G, Mutluoglu M. Images in clinical medicine. Dependent rubor. N Engl J Med 2011; 364 (26) e56
  • 18 Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B. Chronic venous disease. N Engl J Med 2006; 355 (05) 488-498
  • 19 Leone S, Pascale R, Vitale M, Esposito S. [Epidemiology of diabetic foot]. Infez Med 2012; 20 (Suppl. 01) 8-13
  • 20 Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes 2015; 6 (01) 37-53
  • 21 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141