FOOT VOLUMETRY AND DUPLEX ULTRASONOGRAPHY AFTER SAPHENOUS AND SUBFASCIAL PERFORATING VEIN LIGATION FOR RECURRENT VENOUS ULCERATION

Forty-three patients undergoing superficial and perforating vein ligat ion for recurrent venous ulceration underwent preoperative and postope rative foot volumetry and postoperative duplex ultrasonography. Patien ts were followed for a median of 66 (range 18-144) months. Of nine pat ients who developed recurrent ulceration, six had femoral vein incompe tence and all had popliteal vein incompetence demonstrated by duplex u ltrasonography. Of the 34 patients who remained ulcer-free, five had f emoral vein incompetence and a single patient had popliteal vein incom petence on duplex scanning, giving positive predictive values for recu rrent ulceration of 55 per cent (femoral vein incompetence) and 90 per cent (popliteal vein incompetence). Patients with saphenofemoral inco mpetence on late follow-up were also more likely to suffer recurrence. Preoperative foot volumetry with tourniquet occlusion of superficial veins showed that the median expulsion fraction of patients who develo ped recurrent ulcer during follow-up was 0.8 (range 0.6-2.3) per cent compared with 1.5 (range 0.4-2.9) per cent for those who remained ulce r-free (P = 0.025); the median half-refilling time of patients with re current ulcer was 1.5 (range 0.5-5.5) s compared with 5.0 (range 0.5-2 3.0) s for those without recurrence (P < 0.01). Postoperative foot vol umetry showed similar differences. Deep venous incompetence, particula rly of the popliteal segment, as demonstrated by duplex ultrasonograph y and foot volumetry, is a useful predictor of recurrent ulceration af ter subfascial perforator and superficial venous ligation.