Reflux from Thigh to Calf, the Major Pathology in Chronic Venous Ulcer Disease: Surgery Indicated in the Majority of Patients

Abstract

The aim of this study was to define the underlying anatomical and pathophysiological conditions in limbs with venous ulcers in order to get information for the most appropriate treatment selection. Ninety-eight limbs (83 patients, 59 men), with active chronic venous ulcers, were analyzed retrospectively and classified according to the CEAP (clinical, etiological, anatomical, and pathophysiological) classification. Duplex-ultrasound was performed in all patients, while air-plethysmography and venography were performed selectively on potential candidates for deep venous reconstruction. Sixty-six ulcers were primary in origin and 32 were secondary. Reflux was present in all limbs except 1. Isolated reflux in 1 system (superficial = 3, deep = 4, perforator = 3) was seen in 10 legs (10%), while incompetence in all 3 systems was seen in 51 legs (52%). Superficial reflux with or without involvement of other systems was seen in 84 legs (86%), 72 legs (73%) had deep reflux with or without involvement of other systems, and incompetent perforator veins were identified in 79 limbs (81%). Axial reflux (continuous reverse flow from the groin region to below knee) was found in 77 limbs (79%). The femoral vein was the single most common deep venous segment in which either reflux or obstruction was found. Axial distribution of disease was found in the majority of cases and no patient had isolated deep venous incompetence below knee. Primary disease was the predominant etiologic cause and reflux was the main pathophysiological finding. Practically all patients were found to have 1 or more sites of reflux or obstruction that could benefit from operative treatment.

Individually tailored duration of elastic compression therapy in relation to incidence of the postthrombotic syndrome

“…Within the group of patients with PTS, however, duplex testing will still retain its merits for assessment of venous outflow resistance and diagnostic work-up for surgical interventions. [28][29][30] In our cohort, a strong association with PTS was found for varicosities/venous insufficiency. Although part of our patients with varicosities/venous insufficiency experienced an earlier event, the percentage of previous events differed not significantly from patients without varicosities/venous insufficiency and is therefore not likely to explain the association to the outcome of PTS.…”

“…For the small group of patients who develop PTS, more effective treatment options should therefore be established. 29,30,[32][33][34] Some weaknesses of our study have to be addressed. First, our study was not a randomized trial but rather a prospective management cohort study.…”

Effect of age on the biomechanical and microcirculatory properties of the skin in healthy individuals and during venous ulceration

“…[38] Although, estimates of oxygen transport suggest that fibrin cuffs are unlikely to impair diffusion of oxygen significantly[33] with aging the skin immune function is crippled, death of Langerhans cells and the formulation of endothelial adhesion molecules all increases in response to age related hypoxemia and reduced peripheral blood supply. [12417]…”

Identifying the source of superficial reflux in venous leg ulcers using duplex ultrasound

“…7 Abolition of superficial refluxes has been shown to achieve beneficial effects on ulcer healing even in the presence of concomitant deep venous refluxes and can be offered on a general basis. 8,9 In this study, we sought to identify the exact reflux routes associated with medially or laterally located venous leg ulcers. To achieve this aim, we prospectively investigated 183 legs with active leg ulcers presenting with venous reflux, using extended duplex ultrasound examination focusing on the ultimately dominant venous reflux routes in addition to classical venous mapping.…”