Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications – a review of present guidelines

Andriessen, Anneke; Apelqvist, Jan; Mosti, Giovanni; Partsch, Hugo; Gonska, C.; Abel, Martin

doi:10.1111/jdv.14390

Cited by 99 publications

(89 citation statements)

References 46 publications

(161 reference statements)

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“…The final five categories were pilot‐tested using three studies and no further changes were made. There is an acknowledged lack of consensus on the need for the recording of Ankle to Brachial Pressure Index (ABPI) prior to the application of compression for the treatment of VLU and at what ABPI should a person be excluded from receiving compression . We therefore focused on this exclusion criteria in more detail to provide an overview of current practice as it relates to RCTs.…”

Section: Methodsmentioning

confidence: 99%

External validity of randomized controlled trials of interventions in venous leg ulceration: A systematic review

Gethin

Ivory

Connell

et al. 2019

Wound Repair Regeneration

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We set out to evaluate quality of reporting of data related to external validity from randomized controlled trials (RCTs) assessing treatment interventions for active venous leg ulcers. Using a systematic review study design, we identified 144 full‐text RCTs of treatment interventions, where the wound was assessed and published in English from 1998 to 2018. We found that the median study sample size was 75.5. Weighted mean wound size was 13.22 cm2 and weighted mean wound duration was 22.20 months. Forty‐six (32%) reported numbers screened for eligibility and 27 (19%) reported the number who declined to participate; 19 (13%) reported on patient ethnicity; 60 (42%) reported comorbidities; and 5 (4%) reported current medication use. When reported, 60/102 (59%) excluded patients with an ankle‐brachial pressure index <0.8; 68/135 (50%) were conducted in Europe, 6/135 (4%) in Asia, and 74/104 (71%) were conducted in outpatient facilities; 3 (2%) reported socioeconomic factors and 88 (61%) reported on adverse events. We concluded that there is inadequate reporting of data related to external validity in reports of RCTs assessing venous leg ulcers treatment interventions. Significant variability exists in the ankle‐brachial pressure index cutoff point for inclusion or exclusion, making generalizability difficult to assess.

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Section: Methodsmentioning

confidence: 99%

External validity of randomized controlled trials of interventions in venous leg ulceration: A systematic review

Gethin

Ivory

Connell

et al. 2019

Wound Repair Regeneration

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“…Of these, N = 34 were retained for full‐text screening. These retained articles were supplemented by N = 22 full‐text articles provided by the authors or obtained from an article by Andriessen et al (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…CPGs or BPRs were sourced from an article by Andriessen et al through searches of Scopus (inception to present) and PubMed (2000 to present) using the search strategy outlined in Figure or were provided by the authors of this review.…”

Section: Methodsmentioning

confidence: 99%

ABPI reporting and compression recommendations in global clinical practice guidelines on venous leg ulcer management: A scoping review

Weller

Team

Ivory

et al. 2018

International Wound Journal

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Clinical practice guidelines (CPGs) for venous leg ulcer (VLU) management recommend below‐knee compression to improve healing outcomes after calculating the ankle‐brachial pressure index (ABPI) to rule out significant arterial disease. This systematic scoping review aimed to complete a qualitative and quantitative content analysis of international CPGs for VLU management to determine if consensus existed in relation to recommendations for compression application based on an ABPI reading and clinical assessment. Our review shows that there is a lack of consensus across 13 VLU CPGs and a lack of clear guidance in relation to the specific ABPI range of compression therapy that can be safely applied. An area of uncertainty and disagreement exists in relation to an ABPI between 0.6 and 0.8, with some guidelines advocating that compression is contraindicated and others that there should be reduced compression. This has implications in clinical practice, including when it is safe to apply compression. In addition, the inconsistency in the levels of evidence and the grades of recommendation makes it difficult to compare across various guidelines.

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“…21 'The reliance on a single value as a cut-off point for treatment has been debated as it (does not take)… into account differences in perfusion pressure between the three vessels at the ankle -a pressure difference of 15 mmHg or greater indicates a proximal stenosis or occlusion in the vessel with the lower pressure.' (Andriessen et al, 2017)…”

Section: Appendix 1 Abi Guidance Documentmentioning

confidence: 99%

“….T.R.I.D.E. compression selection guide Additionally, there are guidelines that have been published with regards to the use of compression for those with peripheral arterial disease (PAD) or mixed disease, summarised in Box 3.21,[78][79][80][81] …”

mentioning

confidence: 99%

S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity

Bjork¹,

Ehmann

2019

J Wound Care

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Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications – a review of present guidelines

Cited by 99 publications

References 46 publications

External validity of randomized controlled trials of interventions in venous leg ulceration: A systematic review

External validity of randomized controlled trials of interventions in venous leg ulceration: A systematic review

ABPI reporting and compression recommendations in global clinical practice guidelines on venous leg ulcer management: A scoping review

S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity

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