THE DIAGNOSIS AND MANAGEMENT OF MIXED ARTERIAL VENOUS LEG ULCERS IN COMMUNITY-BASED CLINICS/

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.