Venous reflux surgery promotes venous leg ulcer healing despite reduced ankle brachial pressure index

The aim of this study was to demonstrate that venous surgery promotes ulcer healing, even in the presence of peripheral arterial disease.

In this retrospective study, 33 patients (49 legs) with venous leg ulcers and reduced arterial ankle brachial pressure index (< or = 0.8) were followed up 3 months to 7 years (median: 3.11 years) after venous surgery (group I). Venous reflux was considered to be the main cause of ulceration, and no attempt was made to restore the arterial circulation. The results were compared with those of patients with ulcers without arterial occlusive disease (n=190) who were treated following the same principles (group II). The surgical procedure consisted of interruption of reflux in the superficial and/or perforating veins. Additionally, shaving, fasciectomy, and mesh grafting was performed in 36 cases.

In group I, 21 legs were lost to follow-up, 16 due to death. The mortality rate was three times higher in group I than in group II. From 28 legs of group I seen after 0.4-6.7 years (median: 2.9 years), 19/28 legs (68%) were healed compared with 123/145 (85%) in group II after 0.2-7.2 years (median: 3.2 years) (not significant [NS]). Group I showed a significantly longer healing time than group II (P<0.05) (P<0.001). Recurrence was observed in 3/28 (11%) from group I and in 6/145 (4%) from group II (NS). The time course of recurrence showed no statistically significant difference between the groups.

Venous surgery produces beneficial results not only in pure venous ulcerations, but also in patients with accompanying arterial disease.