Venous ulceration is the primary underlying wound etiology in  patients seen in wound care clinics in the United States. Most standard treatment regimens for ulcers associated with venous hypertension incorporate some component of external compression, with the possibility of interventional procedures. Problems occur, when a venous ulceration exists in the patient with underlying ischemic disease.  In the ischemic patient the typical recommended 30-40 mmHg compression at the ankle may reduce arterial flow enough to induce pain, and in severe cases lead to tissue necrosis. Guidance as to the management of mixed arterial disease, can be found in a review article in Wounds 2011 by Dr. William Marston. Some of the topics addressed include: at what level of arterial insufficiency do you modify compression, when should you consider revascularization as the initial therapeutic treatment, and a protocol for the management of mixed arterial/venous ulcerations.

Marston, W. Mixed Arterial and Venous Ulcers, Wounds 2011;23(12):351-356