Hafner J, Schaad I, Schneider E, Seifert B, Burg G, Cassina P C
Department of Dermatology, University Hospital of Zurich, Switzerland.
J Am Acad Dermatol. 2000 Dec;43(6):1001-8. doi: 10.1067/mjd.2000.108375.
Peripheral arterial disease is the only identifiable etiology in approximately 10% of leg ulcers. Clinical data on the management of these chronic wounds are scarce.
We attempted to outline the threshold of systolic ankle pressure and ankle-brachial-index (ABI) below which arterial leg ulcers can occur and to outline the indication for revascularization in arterial leg ulcers.
Diagnostic and outcome analysis was performed for 26 consecutive patients with arterial leg ulcers. We calculated sensitivities, specificities, and receiver operating characteristic (ROC) curves for the identification of arterial leg ulcers among all 223 consecutive leg ulcer patients within a 3-year period, as well as the ROC curve for patients who required revascularization.
The systolic ankle pressure was 88 (18-130) mm Hg (median; 95% confidence interval) and the ABI was 0.60 (0.15-0.86), respectively. Eighteen patients (69%) were subjected to revascularization. By the end of the study, 24 patients (92%) healed completely, 1 improved (90% wound closure), and 1 patient had to undergo below-knee amputation for chronic osteomyelitis. During this study, the ankle pressure and ABI were poor in distinguishing those patients who required revascularization from those who healed without revascularization.
Most arterial leg ulcers do not meet the criteria of chronic critical limb ischemia, but they do not heal under conservative measures, either. A majority of these patients benefit from revascularization and should, therefore, be referred for arterial duplex ultrasound investigation or angiography. In our study, an ankle pressure below 110 mm Hg identified all patients (100%) who were subjected to revascularization procedures. However, controlled clinical studies are required to find the systolic ankle pressure and ABI below which revascularization can be recommended to speed up the healing time.
在大约10%的腿部溃疡中，外周动脉疾病是唯一可识别的病因。关于这些慢性伤口管理的临床数据很少。
我们试图勾勒出收缩期踝压和踝臂指数（ABI）的阈值，低于该阈值可能会发生腿部动脉溃疡，并概述腿部动脉溃疡血管重建的指征。
对26例连续性腿部动脉溃疡患者进行诊断和结果分析。我们计算了在3年期间内所有223例连续性腿部溃疡患者中识别腿部动脉溃疡的敏感性、特异性和受试者工作特征（ROC）曲线，以及需要血管重建的患者的ROC曲线。
收缩期踝压分别为88（18 - 130）mmHg（中位数；95%置信区间），ABI为0.60（0.15 - 0.86）。18例患者（69%）接受了血管重建。到研究结束时，24例患者（92%）完全愈合，1例有所改善（伤口闭合90%），1例患者因慢性骨髓炎不得不接受膝下截肢。在本研究中，踝压和ABI在区分需要血管重建的患者和未进行血管重建而愈合的患者方面表现不佳。
大多数腿部动脉溃疡不符合慢性严重肢体缺血的标准，但在保守治疗下也无法愈合。这些患者中的大多数受益于血管重建，因此应转诊进行动脉双功超声检查或血管造影。在我们的研究中，踝压低于110 mmHg可识别所有接受血管重建手术的患者（100%）。然而，需要进行对照临床研究以找到收缩期踝压和ABI的阈值，低于该阈值可建议进行血管重建以加快愈合时间。
