Residual Venous Reflux after Superficial Venous Surgery Does Not Predict Ulcer Recurrence

• Published in: European journal of vascular and endovascular surgery 2007-07, Vol.34 (1), p.107-111
• Main Authors: Kulkarni, S.R, Barwell, J.R, Gohel, M.S, Bulbulia, R.A, Whyman, M.R, Poskitt, K.R
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Blood Flow Velocity - physiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Photoplethysmography; Prognosis; Recurrence; Superficial venous surgery; Surgery; Ulcer recurrence; Ultrasonography, Doppler, Duplex; Varicose Ulcer - diagnostic imaging; Varicose Ulcer - physiopathology; Varicose Ulcer - surgery; Vascular Patency - physiology; Vascular Surgical Procedures; Venous refill time; Venous reflux; Venous ulceration
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2006.12.033

Objective The aim of this study was to investigate the importance of venous reflux in ulcer recurrence following saphenous surgery. Methods Ulcerated legs (CEAP 5 and 6) with saphenous reflux were treated with superficial venous surgery plus compression as part of a clinical trial. Patients unfit for general anaesthesia (GA) underwent limited surgery under local anaesthesia (LA). Reflux in superficial and deep segments and venous refill times (VRTs) were assessed before surgery and 3–12 months post-operatively using duplex and digital photoplethysmography respectively. Results Of 185 patients treated with surgery, 15 failed to heal and 26 did not have a follow-up duplex. Within 3 years, 25 of the remaining 144 patients (17%) developed ulcer recurrence. Using a Cox regression model, the presence of residual venous reflux and change in reflux pattern were not found to be risk factors for ulcer recurrence (p = ns). LA was used in 4/25 patients who recurred compared to 28/119 who did not (p = 0.60; Chi-square test). For legs with recurrence, median VRT before surgery was 10.5s (range 5–29) compared to 11s (range 6–36) after surgery (p = 0.097, Wilcoxon Signed Rank test). However, in legs without recurrence, median VRT increased from 10s (range 3–48) to 15s (range 4–48) after surgery (p < 0.001). Conclusion Residual reflux following saphenous surgery is not the most important predictor of venous ulcer recurrence. Poor venous function as demonstrated by VRT may be a better predictor of recurrence in these patients.