NEW INSIGHTS INTO THE PATHOPHYSIOLOGIC CONDITION OF VENOUS ULCERATIONWITH COLOR-FLOW DUPLEX IMAGING - IMPLICATIONS FOR TREATMENT

Purpose: This study was conducted to investigate the distribution of r eflux in the veins adjacent to or within the venous ulcer (local) and to correlate it with the pattern of disease of the axial veins (all ve ins away from the ulcer area) of the affected limb. Methods: Forty-thr ee ulcers in 34 legs of 33 patients were examined with color-flow dupl ex imaging. The veins in the area of the ulcer were scanned with a ste rile technique. Results: In 17 legs (50%) there was documented past de ep venous thrombosis. All of the 34 limbs had reflux in the superficia l or deep axial veins either alone or in combination. Fifteen of these limbs (44%) also had perforating vein incompetence, but none had perf orator incompetence alone. Six ulcers showed no evidence of reflux in the local veins when scanned through the ulcer bed despite the presenc e of reflux in the axial veins of the limb. In 13 limbs with 17 ulcers , either the superficial axial veins alone or the deep axial veins alo ne were affected (with or without associated perforator incompetence). Examination of the local veins associated with these 17 ulcers reveal ed a similar pattern of reflux to that seen in the axial veins in 13 c ases, with the remaining 4 ulcers showing no local venous abnormality. The pattern of reflux was less predictable at the local ulcer level i n limbs where both superficial and deep venous incompetence coexisted in the axial veins. Only 7 of the 26 ulcers (27%) in these limbs had s imilar evidence of combined superficial and deep reflux in the local u lcer veins, whereas 10 ulcers (39%) were associated with local reflux in the superficial or deep veins alone. Conclusions: These data show t hat 86% (37/43) of the ulcers had some degree of reflux in the local a rea, the pattern of which may differ from the axial vein disease. Trea tment of the local hemodynamic abnormalities may be an important facto r in the healing of the ulcers and in the prevention of their recurren ce.