Lower extremity arterial disease (LEAD) is a progressive disease caused by systemic atherosclerosis, hardening of arteries caused by buildup of fats and cholesterol, combined with inflammation. This leads to stenosis and possible occlusion of the artery. Symptoms of LEAD can include: 

  • In early stages, may have no symptoms 
  • Red discoloration when legs are down, paleness of legs when elevated 
  • Pain that increases with elevation and activity 
  • Nocturnal pain (occurs at night) 
  • Shiny, taut, and fragile skin; minimal or absent hair on lower extremity 
  • ABI <0.9 

Treatment for LEAD is based on vascular test results (Ankle Brachial Index, or ABI). A referral for evaluation by a vascular specialist may also be indicated. Learn more about the ABI exam. 

At the St. Charles Outpatient clinics, treatment for LEAD often begins with a non-invasive exam called an Ankle Brachial Index (ABI). ABI is an easy test to check the blood flow to your legs and feet. It can be done in 30 minutes by your wound care clinician. 

On the day of your ABI appointment, we will have you lay as flat as possible for 10 minutes. Then your wound care clinician will check the blood pressure in your arms and legs using a manual blood pressure cuff and Doppler, or with an automatic ABI machine. This will feel the same as checking your blood pressure at the doctor’s office except you will be able to hear the sounds (the Doppler is louder than the stethoscope) and we use a gel on your skin where we place the Doppler. We compare the numbers for six different arteries to determine your ABI. This means we will check your blood pressure six times in different places on your arms and legs. 

We will share the final results with you and your doctor so together we can better guide your care. The ABI will be used to determine the safe amount of compression to help your swelling and wound healing. If you have abnormal results, we will refer you for further testing with a vascular surgeon. 

  • An ABI >1.3 indicates calcified arteries and patient should be referred to vascular surgeon for further assessment 

  • An ABI of 0.9-1.3 indicates the patient can probably tolerate full compression (30-40mmHg) 

  • An ABI of 0.5-0.8 indicates lower extremity arterial disease (LEAD); light compression is recommended (20-30mmHg) 

  • An ABI < 0.5 is indicative of severe ischemia and should be emergently referred to a vascular surgeon to avoid loss of limb 

Source:
Wound, Ostomy, and Continence Nurses Society. (2021). Core curriculum: Wound management (2nd ed.).