Abstract Background The aim was to assess healing in patients with mixed arterial and venous leg ulcers after protocol-driven treatment in a specialist leg ulcer clinic. Methods The study included consecutive patients referred with leg ulceration and venous reflux over 6 years. Legs without arterial disease (ankle : brachial pressure index (ABPI) above 0·85) were treated with multilayer compression bandaging and patients with severe disease (ABPI 0·5 or less) were considered for immediate revascularization. Those with moderate arterial compromise (ABPI above 0·5 up to 0·85) were initially managed with supervised modified compression and considered for revascularization if their ulcer did not heal. Healing rates were determined using life-table analysis. Results Of 2011 ulcerated legs, 1416 (70·4 per cent) had venous reflux. Of these 1416, 193 (13·6 per cent) had moderate and 31 (2·2 per cent) had severe arterial disease. Healing rates by 36 weeks were 87, 68 and 53 per cent for legs with insignificant, moderate and severe arterial disease respectively (P < 0·001). Seventeen legs with moderate and 15 with severe arterial disease were revascularized. Of these, ulcers healed in four legs with moderate and seven with severe disease within 36 weeks of revascularization (P = 0·270). Combined 30-day mortality for revascularization was 6·5 per cent. Conclusion A protocol including supervised modified compression and selective revascularization achieved good healing rates for mixed arterial and venous leg ulceration.