A French Practice Survey of Diagnostic Assessment and Compression Therapy for Patients with Venous Leg Ulcers and Peripheral Artery Disease.

Abstract

The primary objective was to observe how vascular physicians diagnose peripheral artery disease (PAD) in patients with venous leg ulcers (VLUs) and the type of compression used in patients presenting VLU-PAD without critical limb threatening ischaemia (CLTI). Secondary objectives were to assess the safety and efficacy of compression. This was a prospective, multicentre survey of physician practices completed by a prospective patient cohort study with a 6 month follow up. Data were collected on VLU-PAD diagnosis and management by physicians, patient and ulcer characteristics, PAD assessment, types of compression used, and compression efficacy and safety. Twenty-two physicians participated, and 141 patients presenting VLU-PAD without CLTI were included (median age 82 years, median wound duration 18 weeks). PAD was diagnosed by colour Doppler ultrasound (97.2%) and or toe blood pressure (TBP) (63.1%). Multilayer bandages were used predominantly (56.7%), regardless of TBP level. In total, 127 patients completed the 6 month follow up, two were lost to follow up and 12 died (of causes unrelated to compression). The ulcer healing rate was 46.5% (37.5% for 30 mmHg ≤ TBP < 60 mmHg, 63.2% for 60 mmHg ≤ TBP < 80 mmHg, and 77.8% for TBP ≥ 80 mmHg). Three patients underwent revascularisation for ischaemia unrelated to compression. Among factors associated with healing, TBP ≥ 60 mmHg and ulcer surface area outperformed ulcer duration and waveform analysis in multivariable analysis. PAD was mainly diagnosed by colour Doppler ultrasound. Compression was not systematically adapted to PAD severity. No compression related adverse event occurred during follow up. TBP emerged as a potential prognostic factor for healing under compression, but this needs to be confirmed in future studies.