title: Outcome of venous stasis ulceration when complicated by arterial occlusive disease.
abstract: OBJECTIVE
  to report the outcome of patients with venous stasis ulceration (VSU) and severe arterial occlusive disease (AOD).
  
  
  METHODS
  retrospective study.
  
  
  METHODS
  using the International Classification of Diseases (ICD-9), codes for VSU and AOD were cross-matched to identify patients from 1989 to 1999 at two tertiary hospitals. Entry into the study required the presence of a VSU and an ipsilateral procedure to improve AOD or major amputation during the same hospitalisation.
  
  
  RESULTS
  fourteen patients (15 extremities) with a mean age of 80 years (range: 47-93) were identified as having VSU and AOD. Mean duration of VSU up to the time of revascularisation or amputation was 6.4 years (range: 4 months-21 years). The mean number of VSUs per extremity was 2.1 and mean wound area was 71 cm(2). Mean ankle-brachial index was 0.46 (range: 0.10-0.78). Nine extremities (60%) had a bypass procedure, 3 (20%) had an interventional procedure, 1 (0.6%) had a lumbar sympathectomy, and 2 (13%) had an amputation. Over a mean follow-up of 2.8 years, 3 extremities (23%) healed of which 2 recurred. On last review, 11 patients with 12 afflicted extremities had expired. Nine of the remaining 10 extremities were not healed at the time of death. Eight of nine bypass grafts remained patent in follow-up or at death and subsequent limb salvage was 100%.
  
  
  CONCLUSIONS
  combined VSU and AOD represents a rare condition predominantly found in elderly patients with multiple comorbidities. Few patients had complete healing despite an arterial inflow procedure and mortality was high over the short term.
authors.affiliation: Division Vascular Surgery, Department of Surgery, Southern Illinois University, School of Medicine, Springfield, Illinois 62794, USA.
authors.forename: W T
authors.initials: WT
authors.lastname: Bohannon
authors.forename: R B
authors.initials: RB
authors.lastname: McLafferty
authors.forename: S T
authors.initials: ST
authors.lastname: Chaney
authors.forename: M A
authors.initials: MA
authors.lastname: Mattos
authors.forename: L A
authors.initials: LA
authors.lastname: Gruneiro
authors.forename: D E
authors.initials: DE
authors.lastname: Ramsey
authors.forename: K J
authors.initials: KJ
authors.lastname: Hodgson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014647:Varicose Ulcer / Q000150:complications* / Q000401:mortality / Q000601:surgery*