Ann Vasc Surg. 2026 Oct 12:S0890-5096(26)00710-7. doi: 10.1016/j.avsg.2026.09.053. Online ahead of print.
ABSTRACT
OBJECTIVE: Up to 1% of patients with chronic venous disease will present with a primary venous Leg Ulcer (VLU). This study aimed to analyze the impact of frailty as measured by the Simple Vascular Quality Initiative-Frailty Score (sVQI-FS) on the outcomes of patients undergoing treatment for a VLU.
METHODS: Between 2012 and 2024, all patients presenting with a VLU were analyzed. Inclusion criteria were an active VLU, in the presence of superficial truncal venous incompetence, and without total deep venous incompetence (classified as involving all 18 named venous segments) on duplex imaging. Frailty was assessed by the sVQI-FS (congestive heart failure, renal impairment, chronic obstructive pulmonary disease, not living at home, not ambulatory, anemia, and underweight status with a BMI of less than 18.5). An sVQI-FS score of 0.3 or greater was considered frail. Demographics and interventions to effect healing were recorded. The primary outcomes were ulcer healing at 24 weeks and VLU recurrence within one year.
RESULTS: 534 patients (61% female, age 67 ± 9 years, mean ± SD) presented with an active VLU. 43% of patients were classified as frail by the sVQI-FS. 31% had their ulcer for >12 months. Frail patients were more likely to have longer ulcer duration (7.1 ± 0.9 vs. 4.7 ± 1.1 months; Frail vs. Non-Frail; Mean ± SD; p=0.001) and have a longer interval before referral compared to non-frail patients (5.6 ± 1.2 vs. 3.9 ± 1.1 months, mean ± SD; p=0.001). Frailty was associated with more severe ulcers as measured by wound bed scores (11 ± 3 vs. 15 ± 5; Non-Frail vs. Frail; Mean ± SD; Frail vs. Non-Frail; p=0.001). The intensity of therapy, as measured by the sum of scheduled and unscheduled clinic visits and all interventions, was 1.8 times higher in the frail group than in the Non-Frail group (p = 0.001). Initial VLU healing was 26 ± 2% and 16 ± 2% at 12 weeks for Non-Frail and Frail, respectively (mean ± SEM; p=0.001). By 24 weeks, initial VLU healing was 67 ± 4% and 38 ± 4%, for Non-Frail and Frail, respectively (p=0.003). Freedom from VLU recurrence was 59 ± 4% and 36 ± 5% at 1 year (mean ± SEM; p=0.002). and 30 ± 6%, and 18 ± 7% at 3 years for Non Frail and Frail, respectively (p=0.002).
CONCLUSIONS: Frailty significantly affects early referral for VLU care, is associated with more severe ulcers, and impacts both VLU healing rates and recurrence rates. Intervening to identify and ameliorate frailty is necessary to enhance VLU care.
PMID:42863661 | DOI:10.1016/j.avsg.2026.09.053