Peripheral arterial disease and its consequences: Considerations for long-term care

Peripheral arterial disease (PAD) in the LTC setting has major consequences in terms of mortality, morbidity, and increased healthcare costs. Complications include pain, chronic skin ulceration, gangrene, amputation, infection, and death. In recent years, medical-legal liability for providers caring for residents with this disease has increased. PAD is complex and involves inflammation and accumulation of lipids in the vascular intima, causing occlusion of blood flow. Chronic occlusive disease causes trophic changes in the extremity that renders skin more fragile and difficult to heal when minor trauma occurs. Noninvasive vascular studies are recommended to establish the diagnosis and quantify amount of occlusion. Management of this disease starts with modification of risk factors. Medications include antiplatelet agents and statins, but their role in healing arterial ulcers is uncertain. Treatment of arterial ulceration consists of wound bed preparation, and chronic skin ulceration related to PAD should be documented in the same manner as pressure ulcers, with care of all chronic wounds in LTC an interdisciplinary function.