SNF472 Improves Limb Blood Perfusion and Walking Ability and Inhibits Progression of Calcification in Femoral Arteries in a Rat Model of Peripheral Artery Disease

Abstract

Objectives: Venous ulcers (VUs) are well-studied in high-income settings and are known to have a significant impact on patients' overall quality of life. However, VUs are generally considered a disease of wealthier countries and have not received the attention they deserve in low-and middle-income countries (LMICs). This study aimed to explore the scope and accessibility of published data on venous ulcers in LMICs.Methods: We conducted a scoping literature search using PubMed, Medline, Embase, and CINAHL. Included studies were peer-reviewed, reported data on VUs, and were performed in LMICs as specified by the 2020 World Bank classifications. Studies performed in high-income countries (gross national income [GNI] per capita greater than $12,535 annually), systematic/scoping/literature reviews, and editorials were excluded. There were no language or date restrictions to our search.Results: In total, 2831 studies were found, of which 312 were included in the final analysis. Most studies were in English (61%), with 22% in Portuguese and 10% in Chinese. All studies included patients with C5 or C6 chronic venous disease, and over 70% of studies were conducted in a tertiary care hospital. Over one-third (38%) focused on treatment for VUs (38% on wound care, 13% on surgical treatment, 8% on ablation procedures). In total, 28 countries were represented. The overwhelming majority of studies were conducted in Brazil (56%) and China (14%), both of which are classified as upper-middle income countries (GNI per capita between $4,046 and $12,535 annually) and have a surgical/obstetric/anesthesia provider density higher than the recommended 20 per 100,000 population. Only 2 studies were performed in low-income countries (GNI per capita below $1,035 annually), both of which reported significant burden due to venous disease among their studied populations. Though all of the regions defined by the World Health Organization were represented, only 10.6% of LMICs in the African region were represented, compared with over 40% of the LMICs in the Pan-American region (Fig).Conclusions: VUs affect patients in low, low-middle, and upper-middle income settings. However, more studies are needed to truly quantify this burden, particularly at the district and community levels. Furthermore, much more work is needed to document the deleterious impact of VUs in African regions. Increased vascular surgical capacity-building and outreach in LMICs, both through intraregional and international partnerships, are essential to understand the burden of VUs in these regions and to scale up local vascular provider density and access to treatment for the patients affected.