The Effect of Percutaneous Intervention on Wound Healing in Patients With Mixed Arterial Venous Disease
| Autor: | Larisse Lee, Donna Mendes, Deva Boone, George J. Todd, Alan Benvenisty, John C. Lantis |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Percutaneous Chronic venous insufficiency Polyesters medicine.medical_treatment Polyurethanes Population Compression stockings Kaplan-Meier Estimate Occlusive Dressings Revascularization Varicose Ulcer Peripheral Arterial Disease Recurrence medicine Humans Ankle Brachial Index Prospective Studies education Prospective cohort study Aged Ultrasonography Doppler Duplex Wound Healing education.field_of_study business.industry Endovascular Procedures General Medicine Middle Aged medicine.disease Combined Modality Therapy Surgery body regions Occlusive dressing Treatment Outcome Venous Insufficiency Female New York City Polyethylenes Cardiology and Cardiovascular Medicine Wound healing business Stockings Compression |
| Zdroj: | Annals of Vascular Surgery. 25:79-86 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2010.09.006 |
| Popis: | Open venous ulcers in patients with combined arterial and venous insufficiency are notoriously hard to treat. Patients with an ankle-brachial index (ABI) of 0.5-0.8 have been shown to heal poorly. Because adequate compression therapy is contraindicated in patients with an ABI of0.7, we decided to undertake an aggressive approach of percutaneous revascularization for these patients.A total of 27 patients with clinical and duplex scan evidence of chronic venous insufficiency, active leg ulcers, and impaired arterial perfusion (ABI:0.7) were treated using a protocol that required performing percutaneous revascularization before ambulatory compression therapy. The patients were followed at 2-week intervals (average) before and after revascularization. Wound measurements and time to complete closure were also recorded.The results of the patients were compared with their own previous wound healing trajectories. Additionally, their healing rate was compared with previously published rates of impaired arterial perfusion venous wound closure; 25% closure at 10 weeks, 50% at 19 weeks. At enrollment, the average ABI and wound sizes were 0.56 and 12 cm(2), respectively. On average, the wounds had remained open for 17 weeks. After the intervention, the average ABI was 0.97, average time taken to complete closure was 10 weeks, closure rate at 10 weeks was 75%, and absolute closure rate was 100%.Although previous studies have shown that closure of mixed arterial venous ulcers occur without arterial intervention, attaining a near normal ABI allows for timelier wound closure. Therefore, we advocate an aggressive approach of percutaneous revascularization in this population. |
| Databáze: | OpenAIRE |
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