Leg ulceration in venous and arteriovenous insufficiency: assessment and management with compression therapy as part of a holistic wound‑healing strategy

01 October 2024


Harikrishna KR Nair, Giovanni Mosti, Leanne Atkin, Rebecca Aburn, Nizam Ali Hussin, Naresh Govindarajanthran, Sriram Narayanan, Georgina Ritchie, Ray Samuriwo, Kylie Sandy-Hodgetts, Hiske Smart, Geoff Sussman, Suzie Ehmann, John Lantis, Christine Moffatt, Liezl Naude, Sebastian Probst, Wendy White.

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Abstract

Introduction

This international consensus document presents the outcomes of an expert panel discussion, convened in October 2023. The discussion aimed to provide best-practice recommendations on the assessment and management of venous and arteriovenous leg ulcers. To this end, the panellists explored the accurate assessment of the venous and arterial aetiologies underlying leg ulceration, as well as the optimal safe and effective management of venous or arteriovenous ulceration using compression therapy as part of a holistic care plan. This consensus document is intended to complement existing published guidance on the management of venous ulceration and use of compression therapy,1,2,3,4 primarily by filling gaps in earlier guidelines on the assessment and management of leg ulcers with a mixed aetiology caused by combined arterial and venous insufficiency (CAVI).

This consensus document has been written for a multidisciplinary readership of generalist and specialist health professionals, including physicians, podiatrists, nurses and allied health professionals, such as physical and occupational therapists. It aims to be inclusive and international, with a relevance to all healthcare settings and consideration for variations in practice; access to resources; and the way services are designed, provided and reimbursed in the medical systems throughout the world. It is hoped that the recommendations in this consensus document will provide health professionals with the skills and confidence to accurately assess chronic venous and/or arterial insufficiency and deliver compression therapy in a timely, safe and effective manner.

Background

Chronic venous insufficiency (CVI), CAVI and resulting leg ulceration have a significant negative impact on quality of life. The global cost of CVI with and without ulceration is in the billions of dollars.5 The reported global prevalence of CVI varies from <1 to 17% in men and <1 to 40% in women; 1–2% of the global adult population have a lower-extremity wound (leg ulcer), with the prevalence increasing to 3% for patients over 65 years old.5 According to a 2023 meta-analysis, venous ulceration has an international pooled prevalence of 0.32% and incidence of 0.17%.6

The above statistics may be an underestimate of the real world burden due to small sample sizes, misdiagnosis and underreporting, especially of people outside of care, patients who self-treat their wounds and those in less-developed nations.6 In addition, prevalence and incidence studies do not always include wounds that are treated without adequate diagnosis.6 Prevalence and incidence statistics may also be influenced by factors such as delays in detection and diagnosis, as identified by a 2022 study in primary care, where the median time after first appearance of a hard-to-heal wound was 8 days to first assessment but 41 days to diagnosis.7 Real-world prevalence would be better understood with higher quality population studies using consistent methods for population data collection and database analysis, for example using a compliant commercial database such as the Blue Health Intelligence research database of administrative claims.8

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Cite

Nair HK, Mosti G, Atkin L, Aburn R, Ali Hussin N, Govindarajanthran N, Narayanan S, Ritchie G, Samuriwo R, Sandy-Hodgetts K, Smart H, Sussman G, Ehmann S, Lantis J, Moffatt C, Naude L, Probst S, White W. Leg ulceration in venous and arteriovenous insufficiency: assessment and management with compression therapy as part of a holistic wound‑healing strategy. J Wound Care. 2024 Oct 1;33(Sup10b):S1-S31. doi: 10.12968/jowc.2024.33.Sup10b.S1.

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