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Clinical Characteristics of Mixed Arteriovenous Leg Ulcers

A Descriptive Study

Marin, Joseph A.; Woo, Kevin Y.

Journal of Wound Ostomy & Continence Nursing: January/February 2017 - Volume 44 - Issue 1 - p 41–47
doi: 10.1097/WON.0000000000000294
Wound Care
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PURPOSE: The purpose of this study was to identify the clinical characteristics of mixed arteriovenous leg ulcers (MLU) that differentiated them from venous leg ulcers (VLU).

DESIGN: Secondary analysis of data from larger electronic database.

SUBJECTS AND SETTING: The sample comprised 1007 persons with lower extremity ulcers. Two hundred sixty three individuals with MLU were compared to 744 individuals with VLU; their ankle brachial indices were 0.51-0.90 and 0.91-.30 respectively. Subjects were drawn from community care settings from across Canada.

METHODS: Data concerning baseline demographic and pertinent clinical characteristics including ulcer history were collected using multiple validated instruments. The Leg Ulcer Assessment Tool was used to collect demographic and pertinent medical history, The Short Form Health Survey 12 and the Euro Wuol 5D (EQ-5D) were used to measure health related quality of life, the numeric pain scales was used to measure character and intensity of pain. Groups were compared using χ2 or Mann-Whitney U.

RESULTS: Individuals with MLU were significantly older, has lower body mass index, a history of smoking, and more comorbid conditions than subjects with VLU. In many cases, clinical presentation was indicative of significant arterial insufficiency including cool extremities, shiny, cracked and inelastic skin, impaired capillary refill, and weak pedal pulses. Ulcer pain was highly prevalent, but overall pain rating was similar between groups. Mixed arteriovenous leg ulcers were associated with lower health related quality of life, greater mobility impairments, and more deficits in self-care and usual activities.

CONCLUSION: Greater knowledge and understanding of the distinct characteristics of MLU is critical for appropriate screening, prevention, assessment and management of persons with this form of leg ulcer. Pain and health related quality of life factors are important considerations when evaluating and managing these patients.

Joseph A. Marin, BScH, BNSc, RN, School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.

Kevin Y. Woo, PhD, RN, FAPWCA, School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.

Correspondence: Joseph A. Marin, BScH, BNSc, RN, School of Nursing, Faculty of Health Sciences, Queen's University, 92 Barrie St, Kingston, ON K7L 3N6, Canada (joseph.marin@queensu.ca).

The authors of this study have no conflicts of interest or financial relationships to report.

© 2017 by the Wound, Ostomy and Continence Nurses Society.