title: Surgical correction of isolated superficial venous reflux reduces long-term recurrence rate in chronic venous leg ulcers.
abstract: 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.
authors.affiliation: Department of Vascular Surgery, Cheltenham General Hospital, Gloucestershire, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Barwell
authors.forename: M
authors.initials: M
authors.lastname: Taylor
authors.forename: J
authors.initials: J
authors.lastname: Deacon
authors.forename: A S
authors.initials: AS
authors.lastname: Ghauri
authors.forename: C
authors.initials: C
authors.lastname: Wakely
authors.forename: L K
authors.initials: LK
authors.lastname: Phillips
authors.forename: M R
authors.initials: MR
authors.lastname: Whyman
authors.forename: K R
authors.initials: KR
authors.lastname: Poskitt
mesh_terms: 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