Surgical correction of isolated superficial venous reflux reduces long-term recurrence rate in chronic venous leg ulcers.
OBJECTIVE
surgical correction of isolated superficial venous reflux in ulcerated legs may reduce short term recurrence rates but the longer term benefits are unknown.


METHODS
prospective non-randomised cohort study.


METHODS
consecutive patients with chronic leg ulcers were prospectively assessed at a one-stop clinic over a 4-year period from July 1995 to July 1999. All patients with ankle brachial pressure indices (ABPI)50.85 were initially treated with weekly four-layer bandaging. Venous duplex studies in all ulcerated legs assessed venous reflux pattern with surgery being offered to all those with isolated superficial reflux, of whom 56% accepted. Patients were advised to wear class two elastic compression stockings after healing.


RESULTS
766 legs in 669 patients were assessed. Six hundred and thirty-three legs had an ABPI50.85, 236 (39%) demonstrating isolated superficial venous reflux. Surgery was performed on 131 of these legs. Twelve and 24 week healing rates were 50% and 72% for operated legs and 62% and 74% for non-operated legs (p=0.67; Kaplan-Meier life table analysis). Recurrence rates at 1, 2 and 3 years were 14%, 20% and 26% for operated legs and 28%, 30% and 44% for non-operated legs (p=0.03; Kaplan-Meier life table analysis).


CONCLUSIONS
surgical correction of superficial venous reflux in legs with chronic leg ulceration may reduce ulcer recurrence rate at 1, 2 and 3 years.
Barwell
J R
JR
Department of Vascular Surgery, Cheltenham General Hospital, Gloucestershire, UK.
Taylor
M
M
Deacon
J
J
Ghauri
A S
AS
Wakely
C
C
Phillips
L K
LK
Whyman
M R
MR
Poskitt
K R
KR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000601:surgery*; D055502:Secondary Prevention; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014647:Varicose Ulcer / Q000000981:diagnostic imaging* / Q000601:surgery*; D014656:Vascular Surgical Procedures; D014945:Wound Healing / Q000502:physiology