Management of mixed arterial and venous leg ulcers

Humphreys, Martyn Lee; Stewart, Andrew; Gohel, Manjit; Taylor, M.; Whyman, M. R.; Poskitt, K. R.

doi:10.1002/bjs.5757

Cited by 102 publications

(77 citation statements)

References 19 publications

(24 reference statements)

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“…309 For patients with VLU and concomitant PAD, use of standard compression has been shown to be safe if ABI $0.80. 303,310,311 Modified compression bandages or compression stockings with lower pressure ratings can be used for ankle systolic pressure $60 mm Hg, digital pressure $30 mm Hg or ABI $0.50 with close monitoring, but only after consultation with a vascular specialist. 309,312 Use of ankle perfusion pressure of 60 mm Hg or greater rather than ABI #0.5 as a cutoff for compression is preferred because this correlates better with tissue perfusion pressure, and any sustained external compression pressure should never exceed this cutoff perfusion pressure.…”

Section: Compressionmentioning

confidence: 99%

“…30 An ABI of less than 0.5 is considered to be indicative of severe arterial disease. 303 Compression of a limb with significant arterial disease could compromise arterial perfusion and potentially result in adverse ischemic sequelae. In a survey study, nearly one third of general surgery consultants surveyed reported that they had encountered ulcers or necrosis as the direct result of compression treatment.…”

Section: Compressionmentioning

confidence: 99%

See 1 more Smart Citation

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

O’Donnell¹,

Passman²,

Marston³

et al. 2014

Journal of Vascular Surgery

575

450

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Section: Compressionmentioning

confidence: 99%

Section: Compressionmentioning

confidence: 99%

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

O’Donnell¹,

Passman²,

Marston³

et al. 2014

Journal of Vascular Surgery

575

450

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“…Approximately 20% of chronic leg ulcers fail to heal under the best standard of care [12,13,14,15,16,17]. Traditionally, wounds not responding to the best conservative standard of care either have to be accepted as intractable or to be repaired surgically, typically with a split-skin mesh graft [19,20,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…They considerably impair the quality of life [9,10,11] and usually require 3–6 months to heal in 60–80% of patients, with approximately 20% remaining refractory to all conservative medical measures [12,13,14,15,16,17]. Skin substitutes derived from cell culture systems [18] have, therefore, been developed and proposed for the use in the latter, difficult-to-heal leg ulcer patients, also with the goal to reduce the need for expensive in-patient skin grafts [19,20,21,22].…”

Section: Introductionmentioning

confidence: 99%

EpiDex® Swiss Field Trial 2004–2008

et al. 2010

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Background: Approximately 20% of leg ulcers remain unresponsive to the best conservative standard of care. So far, these patients could either receive conventional skin grafts or had to accept their intractable wound. Skin substitutes from cell culture may represent a promising alternative to heal a major part of these patients on a non-surgical, potentially more cost-effective basis. Objective: To systematically evaluate the first 68 patients treated in Switzerland (Swiss EpiDex® field trial 2004–2008). Methods: Retrospective study on EpiDex treatment of a complete consecutive series of 68 patients with chronic wounds (66 chronic leg ulcers, 2 sores) unresponsive to best conservative standard of care. The primary end point was complete wound closure within 9 months after transplantation, the secondary end points change of wound surface area, pain reduction and overall judgement by the patient. Adverse effects were infection, dermatitis and others. Calculation of treatment costs was made. Results: By the end of the study, 50/68 (74%) of patients had their wound completely healed [venous 29/37 (78%); mixed 7/9 (78%); others 14/22 (64%)]; 10/68 (15%) had the wound surface area reduced by >50%, and 8/68 (12%) did not respond to the EpiDex treatment. Wound pain disappeared completely in 78% and partially in 13%. Fifteen patients (22%) received antibiotics for wound infection, and 2 (3%) developed dermatitis (not related to the local therapy). Average treatment costs for venous ulcers amounted to EUR 5,357, compared to EUR 5,722–8,622 reimbursed according to the German DRG system (2010) for an in-patient skin graft. Conclusion: EpiDex may effectively heal up to three quarters of recalcitrant chronic leg ulcers. Thus, it represents an intermediate step to avoid costly in-patient split-skin mesh graft treatments. Patients remain mobilized, and a donor site is avoided. Large wound size or a necrotic wound bed limit the use of EpiDex. Otherwise, it offers the opportunity to avoid conventional skin grafts in a significant number of chronic leg ulcer patients.

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“…Modified compression may be used when the ankle brachial pressure index is between 0.5 and 0.85, but below this, the leg should be assessed by arterial duplex and may benefit from angioplasty or surgical bypass. 11 Subintimal angioplasty is particularly valuable in this group, since a long infrainguinal occlusion may be recanalized, which will permit ulceration to heal.…”

Section: Mixed Arterial and Venous Diseasementioning

confidence: 99%

Practical advice for the treatment of venous disease in the elderly

O’Hare

Earnshaw

2008

Phlebology

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Most of the complications of venous disease are more prevalent in the elderly. These patients often present late with advanced disease or active venous ulceration, having suffered significant symptoms for many years. Many are wary of undergoing invasive procedures and co-morbidity is the rule rather than the exception. Symptomatic uncomplicated venous disease (clinical, aetiological, anatomical and pathological elements [CEAP] 2 -3)It is rare for elderly patients to present with uncomplicated veins but occasionally they come to outpatients with longstanding veins and symptoms in the same leg. It is important to examine these patients carefully to exclude coexisting peripheral vascular disease. The use of even lightweight graduated compression hosiery has been shown to improve venous symptoms of discomfort, swelling, fatigue, aching and leg tightness. 1 For many, all that is required is simple reassurance that the risk of future complications is low.

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Management of mixed arterial and venous leg ulcers

Abstract: A protocol including supervised modified compression and selective revascularization achieved good healing rates for mixed arterial and venous leg ulceration.

Cited by 102 publications

References 19 publications

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

EpiDex® Swiss Field Trial 2004–2008

Practical advice for the treatment of venous disease in the elderly

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