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International Angiology 2003 June;22(2):182-7

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

Patterns of venous reflux in limbs with venous ulcers. Implications for treatment

Ioannou C. V. 1, Giannoukas A. D. 1, Kostas T. 1, Kafetzakis A. 1, Liamis A. 1, Touloupakis E. 1, Tsetis D. 2, Katsamouris N. 1

1 Division of Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece 2 Department of Radiology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece


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Aim. To inves­ti­gate the ana­tom­ic dis­tri­bu­tion of vein ­reflux in limbs with ­healed or ­active ­ulcers (CEAP V and VI).
Meth­ods. Sixty limbs (58 patients) belong­ing to CEAP class­es V and VI were iden­ti­fied from 798 limbs (519 patients) with ultra­son­i­cal­ly prov­en chron­ic ­venous insuf­fi­cien­cy (CVI). Age, gen­der, dura­tion of the ­venous ulcer, and his­to­ry of deep ­venous throm­bo­sis were cor­re­lat­ed to the ana­tom­ic dis­tri­bu­tion of the ­venous ­reflux.
­Results. The prev­a­lence of ­active or ­healed ­ulcers in limbs with CVI was 7.5%. Among 60 limbs with ­ulcers, pri­mary CVI was ­present in 34 (56.7%) and post-throm­bot­ic CVI in 26 limbs (43.3%). No dif­fer­ence in age and gen­der was found ­between the 2 ­groups (p=0.2 and p=0.8, respec­tive­ly). How­ev­er, the dura­tion of the ulcer was long­er in limbs with post-throm­bot­ic CVI (p<0.05). The prev­a­lence of per­fo­ra­tor ­reflux was 41.2% (14/34) in limbs with pri­mary CVI and 38.5% (10/26) in limbs with post-throm­bot­ic CVI (p=0.8). Super­fi­cial ­venous insuf­fi­cien­cy, with or with­out per­fo­rat­ing vein ­reflux, was the com­mon­est pat­tern in limbs with pri­mary CVI; it was rare in limbs with post-throm­bot­ic CVI (22/34 or 64.7% vs 2/26 or 7.7%, p<0.01). Deep vein insuf­fi­cien­cy was ­present in 35.3% (12/34) of the limbs with pri­mary CVI and in 92.3% (24/26) of the limbs with post-throm­bot­ic CVI (p<0.01).
Con­clu­sion. Super­fi­cial ­venous insuf­fi­cien­cy, with or with­out per­fo­rat­ing vein ­reflux, was the com­mon­est pat­tern in limbs with pri­mary CVI, where­as, deep ­venous insuf­fi­cien­cy was ­present in most of the limbs with post-throm­bot­ic CVI. The prev­a­lence of per­fo­rat­ing vein ­reflux was com­par­able in both set­tings. Thus, elim­i­na­tion of super­fi­cial ­reflux is expect­ed to ­result in ulcer heal­ing of most limbs with pri­mary CVI, where­as, the value of such treat­ment in post-throm­bot­ic limbs is not clear.

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