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The prevalence of peripheral arterial disease increases with age. The elevated risk of ulcerations leading to amputation among the elderly reflects not only increased rates of peripheral arterial disease and diabetic pathologies but also age-related changes of the integument. Limb salvage is most successful when clinical and educational interventions are utilized that address the etiology of peripheral arterial disease and the physiologic requirements needed to support the integument. Complete and accurate assessment is essential to guide health care providers in formulating efficacious plans of care. Selected interventions may include any combination of pharmaceutical, technological, surgical, and educational approaches. This article reviews the pathology of arterial ulcerations and provides best practice standards for examination and intervention of integumentary disruption as related to arterial pathology.