The exact definition of a chronic wound varies between various national and international medical organizations, but it is generally described as a wound that does not heal in a predictable length of time.
There were at least 8.2 million patients with chronic wounds in 2018, up from 6.5 million in 2009, but those numbers include only national health insurance program (Medicare) beneficiaries, excluding those insured by other health insurance companies or with no medical insurance [1].
Differentiating between the two types can be difficult without proper diagnostic tools that can help clinicians identify the underlying cause. There are several modern methods available, but none are as cost-effective and convenient as the ABI (Ankle-Brachial Index) assessment. Namely, arterial wounds are caused by PAD (Peripheral Arterial Disease), which by itself is a largely asymptomatic disease and can only be reliably diagnosed with an ABI assessment [2-6].
The ABI, a ratio between the blood pressure at the ankle and arm, is markedly different in those with healthy arteries but with venous issues, and those with PAD, making it an excellent indicator of ulcer’s etiology. There are also in-between values in those with both types of ulcers that require a comprehensive, balanced approach to treatment [7].
The answer to the question “Is it possible to measure the ABI in patients with wounds?” is, therefore, a resounding YES and the reason why it is used in numerous epidemiological (and other) studies of lower extremity ulceration. They likewise include a study conducted in India that wanted to evaluate the association between abnormal ABI and clinical outcomes in patients with lower limb ulcers and the differences between prevalence rates in India and worldwide [8].
They found that 84% of examined ulcers were of vascular origin and that 52% of them were arterial ulcers — in contrast to the estimated worldwide prevalence of between 10% and 30% [15]. Additionally, researchers noted that the majority of those patients were males with a history of smoking, which is not surprising given its role as the single most prominent modifiable risk factor for PAD, adding further credibility to the recommended preventive screening for PAD, with special emphasis on patients in risk groups [9-12].
Use of ABI measurement in chronic wound assessment should be a prerequisite step before deciding on the proper treatment regimen, particularly in cases of ulcers with mixed etiology.
At medi, we have the MESI ABPI, which gives patients a reliable reading on extremities to identify PAD in as little as a minute. This method is accurate without serious consequences, eliminates human error, and provides a clear, proper treatment plan.
And, if that treatment plan includes medical compression, we now have the mediven® angio, the only clinically proven medical compression stocking that fits the safety requirements for mid-to-moderate PAD patients with therapeutic treatment needs for chronic venous disease.
References:
[1] An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds > https://www.valueinhealthjournal.com/article/S1098-3015(17)30329-7/fulltext
[2] Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care > https://jamanetwork.com/journals/jama/fullarticle/194205
[3] Leg Symptoms in Peripheral Arterial Disease > https://jamanetwork.com/journals/jama/fullarticle/194250
[4] Reliability of ankle: brachial pressure index measurement by junior doctors > https://www.ncbi.nlm.nih.gov/pubmed/8156330/
[5] Detection of peripheral arterial disease with an improved automated device: comparison of a new oscillometric device and the standard Doppler method > https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973721/
[6] Comparison Of Ankle-Brachial Index (ABI) Measurement Between A New Oscillometric Device (MESI ABPI Md®) And The Standard Doppler Method In The Diagnosis Of Lower Extremity Arterial Disease (LEAD) > http://www.heraldopenaccess.us/fulltext/Non-Invasive-Vascular-Investigation/Comparison-of-Ankle-Brachial-Index-ABI-Measurement-between-a-New-Oscillometric-Device-MESI-ABPI-Md-and-the-Standard-Doppler-Method.php
[7] Doppler assessment and ABPI: Interpretation in the management of leg ulceration > http://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.html
[8] Role of Ankle Brachial Index (ABI) in Management of Non-Healing Ulcers of Lower Limb > https://www.jusurgery.com/universalsurgery/role-of-ankle-brachial-index-abi-in-management-of-nonhealing-ulcers-of-lower-limb.php?aid=21788
[9] The Influence of Smoking Cessation on Hemodynamics and Arterial Compliance > https://journals.sagepub.com/doi/abs/10.1177/0003319706293119
[10] Relationship of smoking and smoking cessation with ankle-to-arm blood pressure index in elderly Japanese men > https://www.ncbi.nlm.nih.gov/pubmed/16575279
[11] Influence of smoking on incidence and prevalence of peripheral arterial disease > https://www.ncbi.nlm.nih.gov/pubmed/15622370
[12] Medical management of claudication > https://www.jvascsurg.org/article/S0741-5214(17)30915-1/fulltext
[20] Smoking Cessation in Peripheral Artery Disease > https://www.acc.org/latest-in-cardiology/articles/2020/03/05/07/53/smoking-cessation-in-peripheral-artery-disease
