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Chronic critical leg ischaemia must include leg ulcers
L Konradsen1, J Wounlund, P Holstein
1Department of Thoracic and Vascular Surgery L, Bispebjerg Hospital, Copenhagen Wound Healing Center, University of Copenhagen, Denmark.
Objectives:
In a previous series on conservative treatment in patients with leg ulcers and severe arterial occlusive disease (systolic digital blood pressure (SDBP) < 30 mmHg) a 70% risk of leg amputation and a negligeable potential for ulcerhealing was found. This series assess the efficacy of arterial reconstruction in such patients.
Design:
Retrospective study of consecutive patients in a department of vascular surgery and of dermatology in cooperation with the wound healing center.
Material And Methods:
Thirty-nine patients with 42 ulcerated legs underwent arterial revascularisation. 88% of the procedures were distal to the inguinal ligament.
Main Results:
One patient died postoperatively (3%). Seven (18%) had wound complications, but none had graft infections. After 1 year the cumulative secondary patency was 90%, ulcer healing 70% and the limb salvage 90%. Thus only four legs (10%) had been amputated.
Conclusions:
Arterial revascularisation for leg ulcers is indicated when conservative treatment fails. Legs with ulceration and SDBP < 30 mmHg should be included in the concept of chronic critical ischaemia.