[Hemodynamic basis for the development of varicose ulcers and their therapy]

The prevalence of leg ulcers is about 1%, approximately 75% of them are of venous origin. The precondition for the development of venous ulcers is ambulatory venous hypertension. It is assumed than a linear correlation exists between the severity of ambulatory venous hypertension and the incidence of venous ulcers. Venous ulcers caused by superficial vein reflux are called varicose ulcers and are more frequent than postthrombotic ones. Crossectomy removes the hemodynamic disorder responsible for the development of varicose ulcers and creates conditions for a quick and mostly definitive ulcer healing. In cases with simultaneous reflux in the saphenous and femoral veins the saphenous reflux is responsible for the severity of venous disorder, whereas femoral reflux is hemodynamically unimportant. Selective abolition of saphenous reflux restores normal hemodynamic conditions in such cases. Compressive therapy continues to be the most frequently used therapeutic procedure in the treatment of venous ulcers; it must be considered as a symptomatic measure, because it is not able to substantially affect the underlying venous disorder in spite of the fact that the correctly lying bandage positively influences venous hemodynamics. The diagnostic procedure in patients with leg ulcers should screen out cases with varicose ulcers; abolition of superficial vein reflux can deliver these patients from their annoying disease.