Early Ankle Brachial Index Testing Is Associated With Decreased Risk of Amputation for Patients With Lower Extremity Ulcers

Abstract

Patients with lower extremity wounds from diabetes mellitus or peripheral artery disease have a risk of amputation as high as 25%. In patients with arterial disease, revascularization decreases the risk of amputation. We aimed to determine whether early assessment of arterial perfusion would correlate with amputation rates. We retrospectively reviewed the data from patients referred to the vascular clinic over 18 months with lower extremity wounds to determine when a complete pulse examination and diagnostic studies to evaluate perfusion were performed. Kaplan-Meier analysis was used to determine whether the timing affected the outcomes for treatment and the risk of amputation. Eighty-nine patients with lower extremity wounds were identified. Of the 89 patients, 52 (58%) had not had a pulse examination performed by their primary care provider when the wound was identified (Table). The patients were classified by when they had undergone ankle brachial index (ABI) testing to assess arterial perfusion. Of the 89 patients, 18 had had early ABI (<30 days) testing and 71 had had late ABI testing. The patients in the early ABI group were more likely to have undergone a pulse examination by their primary care provider than those in the late ABI group (n = 12; 67%; vs n = 25; 34.7%; P = .03). The early ABI group also had had a shorter interval to vascular referral (15 days vs 125 days; P < .001) and a shorter time to wound healing (119 days vs 313 days; P < .001) compared with the ABI late group. Finally, the patients in the early ABI group were less likely to have required amputation (Fig), although the difference was not statistically significant (P = .06). Early ABI testing expedites specialty referral and shortens the time to revascularization. It can also decrease the time to wound healing. Larger cohort studies are required to determine the overall effect of early ABI testing to decrease amputation rates.TablePatient characteristicsCharacteristicPulse examinationP valueNo (n = 52)Yes (n = 37)Age, years68.368.8.84Male gender, no.3128.18Diabetes, no.3827.73Coronary artery disease, no.2615.7COPD, no.104.7Median time to vascular referral, days3661.17Median time to revascularization, days8287.67Median time to wound healing, days217300.77COPD, Chronic obstructive pulmonary disease. Open table in a new tab