Understanding arterial and mixed wounds

Over weeks and months, an arterial wound tends to change slowly instead of shrinking steadily the way a wound with a good blood supply does. It may stay the same size, deepen a little, or form a dry, dark cap. Pain often rises and falls with position and time of day.

What happens next usually depends on circulation. If a vascular specialist is able to improve flow, the wound may begin to respond. If not, the goal may shift to keeping it stable, comfortable and free of infection. Mixed wounds add swings in swelling and drainage. Setbacks commonly follow a new bump, a shoe that rubs or a stretch of illness.

What the treating clinician looks at

A care plan for an arterial wound usually runs on two tracks. One protects the wound: dressings matched to how dry or moist it is, padding and footwear that keep pressure and friction off the area, and a close watch for infection. The other addresses the blood supply, which may mean a referral to a vascular specialist to see whether a procedure could open or bypass the narrowed artery.

The treating clinician sets the order of these steps. Until circulation is understood, the plan tends to be cautious, with an emphasis on keeping stable tissue stable instead of pushing for fast changes at the wound.

Local context: Alton and the Riverbend

Families in the Riverbend sometimes assume a Missouri specialist is the only option for a wound caused by artery disease, or that a plan that works in one state works the same way in the other. Neither is safe to assume. Illinois Medicaid and Missouri plans differ, and vascular testing, procedures and wound visits may each be handled differently. Gateway starts by confirming which partner clinician can see you at your address and what your plan requires, such as a referral or prior authorization. If specialty care does mean crossing the river, we help arrange the appointment, records and transportation.

Each town in the Riverbend has its own housing. Wood River, Roxana, East Alton and Hartford have many compact one-story houses on a street grid, Bethalto and Godfrey have ranch homes and newer subdivisions with more land, and Alton has older houses on hills. Senior apartments, assisted living, and skilled nursing and rehabilitation centers are spread among the towns. Gateway arranges partner clinician visits in homes and facilities throughout the area, and when a patient moves from one town or setting to another, we carry the records, orders and schedule along.

Care at home

At a home visit, the treating clinician sees things a clinic never shows: the shoes by the door, the chair where you spend the afternoon, the bed where a heel rests all night. For an arterial wound those details matter, because pressure and rubbing on a poorly supplied foot can undo careful dressing work.

Gateway schedules the visit, gathers earlier vascular records and test results beforehand, and sends the clinician’s orders where they need to go afterward. For people whose leg pain limits walking, being seen at home removes the hardest part of getting care, which is the trip.

For residents of nursing and senior living communities

Many people arrive at a rehabilitation center after a hospital stay for a vascular procedure, an infection or a toe amputation, with a wound that still needs close follow-up. Therapy adds a complication: the foot has to bear weight and wear a shoe again.

The treating clinician works with facility nursing and therapists on how the wound is protected during sessions, and with the attending physician on orders. Gateway obtains the hospital’s operative and vascular reports, lines up any follow-up visit the surgeon requested, and plans how wound care will continue at home or in long-term care after discharge.

Signs to tell the clinician about

A daily look at both feet catches many problems early. Tell the treating clinician about:

  • A new sore, blister or dark spot on a toe, heel or ankle
  • One foot that feels noticeably cooler than the other
  • Foot pain when lying flat that eases when you hang the foot over the edge of the bed
  • Skin around the wound turning red, shiny or tight
  • A dressing with a new smell or a new color of drainage

Do not wait for the next scheduled visit to mention these. Call 911 if the foot or leg abruptly goes cold, numb and discolored, or if you cannot move it.

Primary care and overall health

Healing draws on the whole body. High blood sugar damages small vessels and weakens the response to infection. Kidney disease, anemia and a poor appetite each limit what reaches the wound. A primary care clinician can check labs, review how well diabetes is controlled, and look at whether you are eating enough protein and calories to rebuild tissue.

When wound care and primary care are arranged together, a wound that stalls prompts a wider look at health and not only a change of dressing. Findings from either visit reach the other clinician through Gateway’s coordination.

Primary care at home in the Riverbend →

How to get started in the Riverbend

You may already have a surgeon, a wound clinic or a home health nurse and still want help with arterial and mixed wound care closer to home in the Riverbend. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

Because the Riverbend covers several towns, start a call with the town and ZIP code, such as 62002 for Alton, 62035 for Godfrey, 62024 for East Alton, 62095 for Wood River or 62010 for Bethalto. Add a phone number, the care setting and the regular doctor, and mention that the address is in Illinois. Availability is confirmed town by town. Gateway also arranges care in Edwardsville and Granite City, which helps when relatives live elsewhere in Madison County.

  • County: Madison County, Illinois
  • ZIP codes: 62002, 62035, 62024, 62095, 62010
  • Nearby hospitals: Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton (not affiliated with Gateway)
  • Nearby communities: Alton, Godfrey, Illinois, Edwardsville, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in the Riverbend

Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in the Riverbend page.

Common questions

Do I need a referral to ask about arterial wound care in the Riverbend?

No. Patients, family members and caregivers in the Riverbend can contact Gateway directly, and hospitals, facilities and physician offices can refer as well. Some health plans do require a referral or authorization before certain visits or tests, and the treating clinician may need earlier records. We explain what is needed for your situation after the first call, before a visit is scheduled.

How can one wound be both arterial and venous?

The legs have two sets of vessels. Arteries carry blood down to the foot and veins carry it back up. Many older adults have disease in both. When weak veins cause swelling and skin breakdown on a leg where the arteries are also narrowed, the result is a mixed wound. It often looks like a venous ulcer, which is why clinicians check arterial flow before treating it as one.

Will Medicare or my insurance cover arterial wound care and circulation testing?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit, test or supply is a covered benefit depends on the treating provider, your specific plan and the care the clinician orders, so we cannot tell you in advance that something is a covered benefit. Have your insurance card handy when you call. We will explain what the treating provider’s office needs and what to ask your plan.

My husband in the Riverbend has a leg ulcer that keeps coming back. Can Gateway help?

Call us and we will work on arranging a visit with a partner wound care clinician. Leg ulcers that return are often tied to circulation or swelling in the legs, and the treating clinician will assess the cause before deciding on treatment. Tell the clinician about earlier ulcers and what was tried. Report spreading redness, fever or sudden pain promptly.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.