While vascular surgical intervention is the exception rather than the rule in treating venous ulcers, the opposite is true for arterial wounds. Most intractable wounds due to arterial insufficiency will require correction of the underlying cause of the wound before there is any chance of healing.
This is not to say most patients with arterial insufficiency require surgery. In fact most patients with arterial insufficiency are asymptomatic. Those who are symptomatic usually present with intermittent claudication, which is calf muscle discomfort or fatigue that occurs upon walking a specific distance and resolves with several minutes’ rest. Patients with intermittent claudication are managed medically. Ninety percent will never require surgery.
On the other hand, when arterial insufficiency advances to the stage where intractable arterial wounds develop, surgical correction should be seriously considered.
In regard to podiatric intervention in patients with arterial disease, be aware that it is unfortunately all too common for an arterial wound to occur coincidentally after a minor podiatric procedure, even after you’ve just trimmed the patient’s nails.
When this occurs, many patients understandably connect the two temporally and unfairly blame the podiatrist for the wound. The smart podiatrist will have recognized and documented absent pulses, but the street-smart podiatrist will have sent the patient for comprehensive peripheral vascular evaluation before even touching the patient. In this case, when the wound occurs, the patient will have been prepared. The patient, podiatrist and vascular specialist become a team to manage the problem.