HEMODYNAMIC AND CLINICAL IMPROVEMENT AFTER SUPERFICIAL VEIN ABLATION IN PRIMARY COMBINED VENOUS INSUFFICIENCY WITH ULCERATION

Purpose: This study was undertaken to determine the degree of clinical and hemodynamic improvement after surgical ablation of incompetent su perficial and perforator veins in limbs with combined deep and superfi cial venous incompetence manifested by chronic dermal ulceration. Meth ods: Eleven limbs in 10 patients with class 5 or 6 venous insufficienc y (ulceration) were assessed by CEAP (clinical, etiologic, anatomic, p athophysiologic) clinical scores, air plethysmography, color duplex ul trasonography, and phlebography (both ascending and descending). Surgi cal ablation of superficial and perforating veins was performed, follo wed by repeat clinical, air plethysmographic, and color duplex ultraso nographic examinations. Results: All 11 limbs had combined deep and su perficial vein reflux on the preoperative color duplex ultrasound scan . Clinical symptom scores decreased from 10 to 1.4 after operation. Po stoperative air plethysmography demonstrated significant reduction in reflux as measured by the mean venous filling index, which decreased f rom 12 +/- 5 ml/sec to 2.7 +/- 1 ml/sec after surgery. Calf pump funct ion was also significantly improved, with a mean ejection fraction tha t increased from 43% +/- 11 to 59% +/- 13 and mean residual volume fra ction that decreased from 56% +/- 15 to 33% +/- 16. Each of these meas ures was significantly different from the preoperative value (p<0.05). Similar improvement characterized subgroups of limbs with three or mo re incompetent deep segments (n = 6) or popliteal segment incompetence (n = 6). Conclusions: Superficial and perforating vein incompetence a ccounts for a substantial and correctable component of venous insuffic iency in limbs with combined deep and superficial vein reflux and veno us ulceration. These data indicate that surgical correction of this co mponent significantly improves clinical symptoms and venous hemodynami cs. Superficial and perforator ablation is an appropriate initial step in the management of combined deep and superficial venous incompetenc e.