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Arterial disease in chronic leg ulceration: an underestimated hazard? Lothian and Forth Valley leg ulcer study
Insights
Many patients with chronic leg ulcers have arterial impairment, a condition that requires careful assessment before compression therapy. Early detection of arterial disease is crucial for effective treatment and preventing complications.
Area of Science:
- Vascular Medicine
- Dermatology
- Podiatry
Background:
- Chronic leg ulcers are a common and challenging clinical problem.
- Arterial impairment is a significant comorbidity in patients with leg ulcers.
- Inadequate assessment can lead to inappropriate treatment and adverse outcomes.
Purpose of the Study:
- To determine the prevalence of arterial impairment in patients with chronic leg ulcers.
- To identify risk factors associated with arterial impairment in this population.
- To emphasize the importance of arterial disease screening before compression therapy.
Main Methods:
- Interview and physical examination of 600 patients with chronic leg ulcers.
- Assessment of pedal pulses and Doppler resting pressure index (RPI).
- Analysis of risk factors including age, ulcer location, and medical history.
Main Results:
- 11% of ulcerated legs had non-palpable pedal pulses.
- 21% of legs had a Doppler RPI of 0.9 or less, indicating arterial impairment.
- Age, foot ulceration, and history of cardiovascular or cerebrovascular disease were significant risk factors.
Conclusions:
- A substantial proportion of patients with chronic leg ulcers exhibit signs of arterial impairment.
- Clinical features of chronic venous insufficiency coexist with arterial disease in approximately half of affected patients.
- Mandatory screening for arterial disease is essential prior to initiating elastic compression therapy for leg ulcers.
Abstract:
Six hundred patients with chronic leg ulcers were interviewed and examined for evidence of arterial impairment. There were 827 ulcerated legs. Pedal pulses could not be felt in 94 (11%). A Doppler resting pressure index of 0.9 or less was found in 176 legs (21%). Risk factors for arterial impairment included age, ulceration affecting the foot, and a history of claudication, ischaemic heart disease, or cerebrovascular disease. Roughly half the patients with arterial impairment also showed the clinical features of chronic venous insufficiency. Careful assessment for arterial disease is mandatory before patients with chronic leg ulcers are treated with elastic compression.