title: Residual venous reflux after superficial venous surgery does not predict ulcer recurrence.
abstract: OBJECTIVE
  The aim of this study was to investigate the importance of venous reflux in ulcer recurrence following saphenous surgery.
  
  
  METHODS
  Ulcerated legs (CEAP 5 and 6) with saphenous reflux were treated with superficial venous surgery plus compression as part of a clinical trial. Patients unfit for general anaesthesia (GA) underwent limited surgery under local anaesthesia (LA). Reflux in superficial and deep segments and venous refill times (VRTs) were assessed before surgery and 3-12 months post-operatively using duplex and digital photoplethysmography respectively.
  
  
  RESULTS
  Of 185 patients treated with surgery, 15 failed to heal and 26 did not have a follow-up duplex. Within 3 years, 25 of the remaining 144 patients (17%) developed ulcer recurrence. Using a Cox regression model, the presence of residual venous reflux and change in reflux pattern were not found to be risk factors for ulcer recurrence (p=ns). LA was used in 4/25 patients who recurred compared to 28/119 who did not (p=0.60; Chi-square test). For legs with recurrence, median VRT before surgery was 10.5s (range 5-29) compared to 11s (range 6-36) after surgery (p=0.097, Wilcoxon Signed Rank test). However, in legs without recurrence, median VRT increased from 10s (range 3-48) to 15s (range 4-48) after surgery (p<0.001).
  
  
  CONCLUSIONS
  Residual reflux following saphenous surgery is not the most important predictor of venous ulcer recurrence. Poor venous function as demonstrated by VRT may be a better predictor of recurrence in these patients.
authors.affiliation: Department of Vascular Surgery, Cheltenham General Hospital, Stanford Road, Cheltenham, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Kulkarni
authors.forename: J R
authors.initials: JR
authors.lastname: Barwell
authors.forename: M S
authors.initials: MS
authors.lastname: Gohel
authors.forename: R A
authors.initials: RA
authors.lastname: Bulbulia
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; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography; D011379:Prognosis; D012008:Recurrence; D018616:Ultrasonography, Doppler, Duplex; D014647:Varicose Ulcer / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D014654:Vascular Patency / Q000502:physiology*; D014656:Vascular Surgical Procedures