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The effective management of venous ulceration
Insights
Direct perforating vein incompetence is a key cause of lower leg venous ulcers. Surgical ligation and compression therapy show high healing rates, suggesting improved treatment optimism.
Area of Science:
- Vascular Surgery
- Dermatology
- Phlebology
Background:
- Venous ulceration is a common and debilitating condition.
- The role of perforating veins in venous ulceration etiology requires further investigation.
Purpose of the Study:
- To evaluate the significance of direct perforating veins in the development of lower leg venous ulceration.
- To assess the long-term efficacy of surgical intervention for incompetent perforating veins.
Main Methods:
- A 6-year prospective study involving 77 patients with 109 ulcerated legs.
- Diagnosis of incompetent perforating veins using clinical examination, Doppler ultrasound, and intraoperative confirmation.
- Treatment included subfascial ligation of perforating veins, saphenous vein stripping when indicated, and elastic compression stockings.
- Deep vein incompetence was assessed via non-invasive methods and phlebography.
Main Results:
- Incompetent perforating veins were identified in 108 out of 109 ulcerated legs.
- Following surgical intervention and compression, 91 ulcers (84.3%) remained healed, with 76% followed for over 3 years.
- Excluding patients with rheumatoid arthritis, 88 (92%) of 96 ulcerated legs achieved sustained healing.
Conclusions:
- Incompetent perforating veins are critically important in the etiology of venous ulceration.
- Surgical management of perforating vein incompetence offers a high success rate for venous ulcer healing.
- These findings support a more optimistic approach to treating venous leg ulcers.
Abstract:
The importance of the direct perforating veins of the lower leg in the aetiology of venous ulceration is supported by the results of a 6-year study of 77 patients with 109 ulcerated legs. Incompetent perforating veins were demonstrated by examination and Doppler ultrasound, and confirmed at operation, in 108 legs. Subfascial ligation of these veins, with stripping of incompetent saphenous veins when necessary, was followed by elastic compression stockings in 44 legs (40 per cent) in which deep vein incompetence was demonstrated by non-invasive methods and phlebography. Some 91 ulcers (84.3 per cent) remain healed (76 per cent greater than 3-year follow up). Eight patients with rheumatoid arthritis in addition to venous incompetence had a 75 per cent failure rate. If these patients are excluded, 88 (92 per cent) of 96 ulcerated legs remain healed. It is submitted that these results support the argument for the importance of perforating vein incompetence in the aetiology of venous ulceration. They also suggest that a more optimistic attitude towards treatment is justified.