Assessing Patient Preferences for Management of Mixed Arterial and Venous Leg Ulcers

Abstract

Introduction Management of Mixed Arterial Venous Leg Ulcers (MAVLU) represents a clinical dilemma. The ideal sequencing of intervention ‘veins-first’ vs ‘artery-first’ remains uncertain. With the paucity of current MAVLU guidelines, we evaluated our patients’ preferences to help establish momentum in developing clinical evidence. Methods This is a prospective, cross-sectional study to elicit patient preferences using the Discrete Choice Experiment (DCE). The DCE task contained the two options veins-first vs artery-first intervention. The block randomisation method was utilised to provide alternating order of the choice set. Through in-person structured interviews, five main aspects (attributes) of each intervention were discussed to allow comparison (type of anaesthesia, duration and complexity of intervention, associated risks, and post-operative stay). Once the preference has been expressed, patients were asked to rank these attributes in order of importance to indicate their influence on decision-making. Results Of 30 patients of MAVLU reviewed over a 12-month period, 26 were suitable for inclusion. 77% of patients (20/26) opted for a veins-first approach. The lower procedural risk associated with venous intervention was the most important attribute in the veins-first group. Similarly, most of those who chose the artery-first approach (6/20) believed that the higher risk profile and complexity or arterial interventions are an unavoidable necessity to achieve ulcer healing. Conclusion ‘veins-first’ approach in treating MAVLU was the predominant choice in our case series. Holistic risk-benefit assessment is essential in joint decision making.