Role of arteriovenous shunting in venous ulcers--therapeutic implications.
Although the presence of arteriovenous communications in patients with chronic venous ulcers has been confirmed in several studies, their role in the pathogenesis of venous ulcers is still uncertain. They possibly do play an important role in the aetiology of chronic venous insufficiency. There is also substantial evidence to suggest that arteriovenous communications develop as a result of chronic venous hypertension. The question raised in this pilot study was whether the importance of arteriovenous shunts in the genesis of venous ulcer disease is such that their obliteration might lead to long-term healing. This clinical study was also designed to determine whether therapeutic microembolization of nutritive arterial branches to arteriovenous fistulas, found in patients with venous ulcers, facilitates healing of venous ulcers resistant to previous conservative and/or classical surgical treatment. From 1997 to 1999, 34 patients (22 women and 14 men, mean age 51.3 years) with chronic venous ulcer resistant to classical treatment were included in the study. Arteriovenous shunting was demonstrated by digital subtraction angiography in 31 patients (31/34 = 91%). The embolization procedure of muscular arterial branches feeding the arteriovenous shunts with microspirals and microparticles led to ulcer healing in 13 patients (13/31). The results suggest that the role of arteriovenous shunting in chronic venous ulceration resistant to classical treatment is more important than previously suggested, and that their microembolization might lead to complete healing.
Flis
V
V
Department of Vascular Surgery, and General Hospital Maribor, Slovenia.
Matela
J
J
Miksić
K
K
Pavlović
M
M
Mrdja
B
B
D000792:Angiography; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000000981:diagnostic imaging / Q000628:therapy*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology