Modified compression therapy in mixed arterial–venous leg ulcers: An integrative review

Abstract

Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt identification of concomitant arterial occlusive disease is critical to determine underlying aetiology and subsequent management. This integrative review presents the current evidence to establish the role of modified compression therapy (MCT) in treatment of mixed arterial venous leg ulcers (MAVLU). A literature search was conducted using the electronic databases CINAHL, MEDLINE, PUBMED, and Embase. Ten studies met the eligibility criteria and were subsequently analysed. Our review concludes that MCT, with compression pressures between 20 and 30 mmHg, can promote healing in MAVLU with moderate arterial insufficiency (0.5 ≤ ABPI ≤0.8). If ABPI is <0.5, MCT can be considered once restoration of acceptable ABPI is achieved.Intolerance, lack of response or further deterioration of disease within 3 months should prompt further arterial imaging and intervention. MCT is generally well tolerated with no adverse outcomes reported. A holistic yet individualised approach is vital in order to account for all factors influencing this patient-led decision-making process, ultimately ensuring effective treatment, which improves patient's quality of life and reduces socioeconomic burden of the disease.

Lower leg ulcer diagnosis and principles of treatment

“…We found one review investigating treatment for the mixed ulcers and arterial ulcers (MAVLU), i.e. VLUs with coexisting PAD, and presented the effect of the MCT with or without revascularisation depending on patients ABI (85). Lim and colleagues showed that MCT with a pressure between 20 and 30mmHg can promote healing in mixed ulcers when moderate arterial insufficiency is present (0.5 ≤ ABI ≤0.8), but if ABI is <0.5 (arterial ulcers), MCT can only be considered when acceptable ABI is achieved (87).…”

Modified Compression Therapy in Mixed Arterial-Venous Leg Ulcers: An Integrative Review

“…Since this review was undertaken in May 2019, the National Wound Care Strategy Programme (NWCSP) has developed evidence-informed recommendation and outlines pathways to support development of local protocols in preventing, assessing, and treating patients with leg ulcers. 40 The body recognises the importance of optimising the correct use of healthcare resources while improving healing, and signpost clinicians to relevant clinical guidelines or evidence, with the aim of ultimately providing a national equitable, accessible, and standardised care.…”

Haemodynamic effect of a leg compression bandage on the distal posterior tibial artery using 4D flow magnetic resonance imaging: A quantitative study

“… 3 Peripheral vascular pathology entails high costs and a decrease in patients' quality of life. 4 , 5 …”

“… 7 , 8 The application of compression bandage has been considered a contraindication in the presence of arteriopathy due to the possible association of an ischemic effect induced by the bandage. 5 , 9 , 10 In arteriovenous ulcers, the lack of application of this treatment means that the venous part of the disease is ignored, delaying the healing process of the ulcer. 11 The existing evidence on this treatment for those ulcers is still insufficient or low and there is little agreement on the pressure used.…”

“… 11 The existing evidence on this treatment for those ulcers is still insufficient or low and there is little agreement on the pressure used. 5 , 12 …”