Ask. Ghauri et al., THE DIAGNOSIS AND MANAGEMENT OF MIXED ARTERIAL VENOUS LEG ULCERS IN COMMUNITY-BASED CLINICS/, European journal of vascular and endovascular surgery, 16(4), 1998, pp. 350-355
Objectives: to assess a management protocol for mixed arterial/venous
leg ulcers in a community service. Design: two-year prospective study
of outcome with intention of assessing limbs with mixed arterial/venou
s ulcers when managed by a new protocol. Method: limbs were assessed f
or venous reflux by duplex and arterial insufficiency by ankle-brachia
l pressure index (ABPI) and defined into three categories: ABPI> 0.85,
0.5>ABPI less than or equal to 0.85 (moderate), ABPI less than or equ
al to 0.5 (severe). Four-layer compression was applied to limbs with v
enous and moderate arterial disease with treatment failure triggering
arterial imaging and revascularisation. Limbs with venous and severe a
rterial disease were investigated for revascularisation. Results: of 2
67 consecutive limbs, 221 had pure chronic venous ulcers and 46 had mi
xed arterial/venous ulcers with 33 having moderate and 13 having sever
e arterial disease. Thirty-six week healing rates for chronic venous,
moderate arterial/venous and severe arterial/venous ulcers were 79%, 6
4% and 23%, respectively. Conclusion: limbs with mixed moderate arteri
al/venous ulcers achieved rates comparable with venous ulcers with thi
s protocol although nurse-led surveillance was required. Limbs with mi
xed severe arterial/venous ulcers healed slowly despite an aggressive
approach to correct arterial disease.