VENOUS HEMODYNAMIC ABNORMALITIES IN PATIENTS WITH LEG ULCERATION

PURPOSE: Venous ulceration in the leg has been predominantly associate d with deep venous insufficiency, although a few reports have implicat ed the superficial veins. The aim of this study was to identify the di stribution of valvular incompetence in patients with active leg ulcera tion, PATIENTS AND METHODS: Color now duplex imaging (CFDI) ultrasonog raphy was used to evaluate the entire venous system-superficial, perfo rator and deep-from groin to ankle in 112 limbs of 94 patients with ve nous leg ulcers. RESULTS: Seventy two limbs (64%) had multisystem inco mpetence and 36 (32%) had one system involved only, whereas in 4 limbs (4%) there was no venous incompetence. Deep venous reflux exclusively was present in 7 limbs (6%) and the perforator system alone was invol ved only in 3 limbs (3%), However, isolated superficial incompetence w as seen in 26 extremities (23%) and combination of superficial with pe rforator system alone in 23 (21%). In addition, reflux overall in the superficial system (alone and in combination with perforator and deep systems) was seen in 94 limbs (84%). The most common pattern (28%) of abnormality was reflux in all systems, superficial, perforator, and de ep, CONCLUSIONS: The results of this study show that variable combined patterns account for over two thirds of patients with ulceration. No comprehensive surgical policy for alleviating ulceration can be justif ied; we suggest that a complete evaluation of all venous systems from groin to ankle with CFDI ultrasonography in patients with venous ulcer ation is practical on a routine basis and will be particularly valuabl e before surgery in order to target intervention at specific incompete nt sites.