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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.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery

|January 1, 1996

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Arterial revascularization significantly improves outcomes for leg ulcers in patients with severe arterial disease. This procedure offers a high chance of healing and limb salvage, drastically reducing amputation rates.

Area of Science:

Vascular Surgery
Wound Healing
Arterial Occlusive Disease

Background:

Conservative treatment for leg ulcers with severe arterial occlusive disease (systolic digital blood pressure < 30 mmHg) has a high amputation risk (70%) and low healing potential.
This study evaluates the efficacy of arterial reconstruction in this challenging patient group.

Purpose of the Study:

To assess the effectiveness of arterial revascularization in patients suffering from leg ulcers and severe arterial occlusive disease.
To determine the impact of arterial reconstruction on limb salvage and ulcer healing rates in this population.

Main Methods:

Retrospective analysis of consecutive patients undergoing arterial revascularization.
Procedures primarily involved distal bypasses (88%) to the inguinal ligament.

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Data collected from vascular surgery, dermatology, and a wound healing center.

Main Results:

High success rates: 90% secondary patency, 70% ulcer healing, and 90% limb salvage at 1 year.
Low amputation rate: only 10% of legs were amputated.
Postoperative complications were manageable, with a 3% mortality rate and 18% wound complications, but no graft infections.

Conclusions:

Arterial revascularization is a viable and indicated treatment for leg ulcers when conservative measures fail.
Legs with ulceration and systolic digital blood pressure < 30 mmHg should be considered within the scope of chronic critical limb ischemia management.