title: Simultaneous superficial venous surgery and on-table subintimal angioplasty in the treatment of venous leg ulcers with arterial compromise.
abstract: OBJECTIVE
  To determine the feasibility of synchronous superficial venous surgery and on-table subintimal angioplasty in the treatment of venous ulcers with arterial compromise.
  
  
  METHODS
  Between January 1992 and December 2004, 9 patients (8 women; median age 83 years, range 72-92) underwent the synchronous procedure. No patient had deep venous reflux; 4 patients presented with rest pain and 2 were diabetic. Their medical records were retrospectively reviewed to gather data on clinical assessment, ankle-brachial index (ABI), lower limb arterial and venous duplex scans, and treatment variables.
  
  
  RESULTS
  Angioplasty was technically successful (median ABI improvement 0.31, range 0.23-0.34) in all procedures, which lasted a median 85 minutes (range 60-160). The procedure was performed under general anesthesia in 7 patients, local in 1, and spinal in 1. Superficial venous surgery was performed first in 8 patients: 6 had great saphenous vein (GSV) ligation without stripping, followed by subintimal angioplasty, and 1 also had small saphenous vein (SSV) ligation. One patient underwent SSV ligation first, followed by angioplasty; another had GSV disconnection and stripping, followed by angioplasty. In 1 patient, angioplasty preceded GSV surgery. One patient required repeat angioplasty 1 week later for re-occlusion. All ulcers healed (median 4 months, range 1-36). Five patients died during a median 32-month follow-up (range 4-82) from unrelated causes; there was 1 ulcer recurrence at 3 years in a patient who declined further investigation and treatment.
  
  
  CONCLUSIONS
  Simultaneous superficial venous surgery and on-table subintimal angioplasty is a safe and novel strategy in the management of a select subgroup of patients with venous ulcers and coexistent arterial compromise.
authors.affiliation: Department of Vascular & Endovascular Surgery, Leicester Royal Infirmary, UK. ckarkos@hotmail.com
authors.forename: Christos D
authors.initials: CD
authors.lastname: Karkos
authors.forename: Charlotte
authors.initials: C
authors.lastname: Holbrook
authors.forename: Sotirios A
authors.initials: SA
authors.lastname: Makris
authors.forename: Guy
authors.initials: G
authors.lastname: Fishwick
authors.forename: Nicholas J M
authors.initials: NJ
authors.lastname: London
authors.forename: A Ross
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000628:therapy*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D008026:Ligation; D008297:Male; D012501:Saphenous Vein; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000150:complications* / Q000601:surgery / Q000628:therapy*