To analyze outcomes of initial combined arterial and venous interventions (AVI) compared with isolated venous interventions (VI) alone in patients with mixed arterial-venous ulcer (MAVLU).
Methods
Between 2012 and 2022, all patients presenting with MAVLU, defined as having a venous ulcer with a Toe Brachial Index <0.7 or an absolute toe pressure <60 mmHg. Two groups were identified: VI and AVI. The primary outcomes assessed were ulcer healing at 12 weeks and freedom from ulcer recurrence within 1 year.
Results
303 patients (57% female; mean age 59 ± 11 years) presented with active MAVLU; 44% underwent VI, and 56% underwent AVI. The Wound Bed Score was more severe in the AVI group compared to the VI group. In addition to medical and wound care therapies used across the entire cohort, venous ablation with thermal or nonthermal modalities was performed in 93% of cases, sclerotherapy in 61%, stab phlebectomy in 39%, and iliac vein stenting in 4%. In the AVI group, 76% of patients underwent endovascular arterial intervention, while 24% had open bypass procedures. All arterial procedures were successful and resulted in an increased TBI. Ulcer healing rates at 12 weeks were 9% for the VI group and 28% for the AVI group (mean; p = .01). At 1 year, freedom from ulcer recurrence was higher in the AVI group (87 ± 3%) compared to the VI group (64 ± 3%; mean ± SEM p = .01).
Conclusion
Compared to isolated venous interventions, combined arterial and venous interventions accelerate initial ulcer healing and reduce ulcer recurrence in MAVLU.
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