title: The effect of percutaneous intervention on wound healing in patients with mixed arterial venous disease.
abstract: BACKGROUND
  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 of <0.7, we decided to undertake an aggressive approach of percutaneous revascularization for these patients.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: St. Luke's-Roosevelt Hospital, Columbia University, New York, NY 10025, USA. jcl161@columbia.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Lantis
authors.forename: Deva
authors.initials: D
authors.lastname: Boone
authors.forename: Larisse
authors.initials: L
authors.lastname: Lee
authors.forename: Donna
authors.initials: D
authors.lastname: Mendes
authors.forename: Alan
authors.initials: A
authors.lastname: Benvenisty
authors.forename: George
authors.initials: G
authors.lastname: Todd
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009519:New York City; D009779:Occlusive Dressings; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011091:Polyesters / Q000627:therapeutic use; D011095:Polyethylenes / Q000627:therapeutic use; D011140:Polyurethanes / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014647:Varicose Ulcer / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D014945:Wound Healing
chemical_list: C117408:Acticoat; D011091:Polyesters; D011095:Polyethylenes; D011140:Polyurethanes; C081143:allevyn