Venous ulceration and saphenous ligation

Early clinical outcomes after subfascial endoscopic perforator surgery (SEPS) and saphenous vein surgery in chronic venous insufficiency

“…A review of the literature on the ligation of perforators ligation and ligation of the saphenous vein alone yielded conflicting results [2,13,15,17]. Recently, Rhodes et al reported improvement in the venous hemodynamics after SEPS with ablation of the superficial reflux in a series of 26 patients [13].…”

“…Early results suggested that it allowed faster ulcer healing and had a good clinical outcome [4,5,10]. However, there is still some controversy about its indications and the role of the ligation of calf perforators in CVI [2,13,15,17]. Herein we report our experience with the early clinical outcomes of SEPS and saphenous vein surgery in a prospective series of Chinese patients who presented with severe chronic venous insufficiency.…”

Current Management of Venous Ulceration

“…This is important, because it has been shown that when venous ulceration is due to superficial and perforator vein incompetence alone, surgical treatment may heal up to 90 percent of ulcers. [33][34][35] The prevalence of perforator and deep vein involvement increases with the severity of the disease and is significantly higher in patients with chronic venous insufficiency classes 4 through 6 compared with classes 0 through 3. 36 -38 It has been reported that deep vein insufficiency alone or in combination with the perforator veins is responsible for 12 percent of venous ulcers, but the overall involvement of the deep venous system is as high as 56 percent in patients with severe chronic venous insufficiency.…”

Randomized clinical trial of compression plus surgery versus compression alone in chronic venous ulceration (ESCHAR study)—haemodynamic and anatomical changes

“…Surgical correction of superficial venous reflux in legs with chronic venous ulceration may reduce long-term ulcer recurrence 1,2 . Coexistent deep venous incompetence has been considered a relative contraindication to surgical intervention and deep venous surgery remains of unproven value 3 .…”

“…Venous colour duplex imaging has been widely used in ulcerated legs to detect those with superficial venous reflux in which surgical correction may confer clinical benefit 1,2,10,11 . Venous refill time (VRT), as measured by digital photoplethysmography, gives a valid approximation to that derived from direct pressure measurements and is a useful indicator of the haemodynamic state of the leg 12,13 .…”