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Calf pump function in patients with healed venous ulcers is not improved by surgery to the communicating veins or by
M C Stacey1, K G Burnand, G T Layer
1Department of Surgery, St Thomas' Hospital, London, UK.
Insights
Surgical intervention combined with compression stockings improved calf muscle pump function in patients with healed venous ulcers, particularly those without post-thrombotic changes. This enhancement may reduce ulcer recurrence rates.
Area of Science:
- Vascular Surgery
- Phlebology
- Biomedical Engineering
Background:
- Venous ulcers often result from impaired calf muscle pump function.
- Assessing calf muscle pump function is crucial for managing venous insufficiency.
- Post-thrombotic changes can significantly impact venous ulcer healing and recurrence.
Purpose of the Study:
- To evaluate the effect of surgical intervention combined with compression stockings on calf muscle pump function after venous ulcer healing.
- To compare the efficacy of surgery plus compression stockings versus compression stockings alone.
- To investigate the influence of post-thrombotic changes on treatment outcomes.
Main Methods:
- 41 limbs with healed venous ulcers were randomized into two treatment groups.
- Group 1: Ligation of incompetent communicating veins, ablation of incompetent superficial veins, and graduated compression stockings.
- Group 2: Graduated compression stockings alone. Calf muscle pump function was assessed using foot volume plethysmography (measuring half volume refilling time and relative expelled volume) at baseline and after 12 months.
Main Results:
- Neither group showed significant improvement in half volume refilling time.
- Relative expelled volume did not improve significantly with stockings alone.
- A slight but significant improvement in relative expelled volume was observed with surgery and stockings (P=0.048), though still below normal ranges.
- Limbs without post-thrombotic changes treated with surgery and stockings showed a significant EVrel improvement (P=0.035).
Conclusions:
- Surgical eradication of incompetent veins combined with compression stockings offers a modest improvement in calf muscle pump function, especially in patients without post-thrombotic syndrome.
- This functional improvement may contribute to the observed reduction in venous ulcer reulceration rates following such combined treatment.
- Further research is warranted to optimize treatment strategies for patients with post-thrombotic changes.
Abstract:
Calf muscle pump function was assessed in 41 limbs after venous ulcers had healed. Treatment was then randomized either to ligation of incompetent lower leg communicating veins and ablation of incompetent superficial veins combined with permanent graduated compression elastic stockings, or to graduated compression elastic stockings only. Half volume refilling time (TV1/2) and relative expelled volume (EVrel) measured on foot volume plethysmography were used to assess calf muscle pump function. This was repeated after 12 months. The initial TV1/2 and EVrel were significantly lower than for normal limbs. There was no significant improvement in TV1/2 in either treatment group (Student's t test, P = 0.78, P = 0.19). EVrel did not improve significantly in limbs treated with elastic stockings alone (P = 0.94), but there was a slight but significant improvement in EVrel in limbs treated with surgery and elastic stockings (P = 0.048); however, this was still significantly below the normal range (P less than 0.001). In limbs without phlebographic evidence of post-thrombotic changes, treated with the combination of surgery and elastic stockings, there was a significant improvement in EVrel (P = 0.035), but no improvement was found in limbs with post-thrombotic changes. This small but significant improvement in EVrel in limbs without post-thrombotic changes treated by surgery and elastic stockings may explain the reduced incidence of reulceration that has been found following surgical eradication of the superficial and communicating veins.