Ulcus venosum cruris--etiopathogenesis, clinical features and surgical treatment

Abstract

INTRODUCTION: Treatment of venous ulcerations should be based on etiopathogenetic characteristics. Previous biochemical, histological and clinical investigations show that there are two types of venous ulcerations: caused by superficial venous insufficiency (SU) and by deep venous insufficiency or obstruction (DU). Both types include communicative (perforate) vein incompetence. Different procedures are used to block pathological blood reflux and they depend on the type of ulceration. OBJECTIVE: Aim of the study was to evaluate short-term and long-term follow-up of different surgical procedures in superficial, communicant and deep veins that depend on the type of ulceration. METHOD: Patients with venous ulcerations are divided into two groups: C(5-6)EpsAspPr (equivalent to SU) and C(6-6)EpsAdpPro (equivalent to DU) according to CEAP classification. In the first group operative treatment involved superficial and perforating veins, and in the second group operative treatment involved deep and perforating veins.We used chi2 test to compare the groups. RESULTS: Venous ulcerations are more often in women (59.1%) than men (40.9%), on the average in their late sixties. Clinical signs of venous stasis and trophic changes are more often in DU than SU. Patients with SU were operatively treated on superficial (136 partial or complete stripping of main veins), communicating (25 ligatures, 22 subfascial shearing) or by combined procedures on superficial and communicating veins (80). Patients with DU were operatively treated by perforator's ligature (17), subfascial perforator's shearing (12), superficial vein operations (4), sapheno-popliteal anastomoses (18), de Palma bypass (13) and interposition of healthy saphena segment (1). Long-term follow-up was registered after 5-15 (on average 3.7) years in 75 (58 SU and 17 DU) patients. Relapse of ulcerations were detected in 9 (15.5%) SU and 3 (17.6%) DU, i.e. (16.0%) of all operated patients with venous ulcers. CONCLUSION: In patients undergoing surgery for chronic venous insufficiency (2.274) more often present with SU (263) than DU (65). Patients with DU had more significant trophic changes and pathological blood reflux that required reconstructive procedures of deep veins. CEAP classification is equivalent to etiopathogenetic types of venous ulcerations and it is appropriate for follow-up of clinical characteristics and results of venous ulceration treatment.