ROLE OF SAPHENOUS-VEIN SURGERY IN THE TREATMENT OF VENOUS ULCERATION

Background This paper describes local anaesthetic saphenous disconnect ion in elderly patients for the treatment of venous ulceration in legs with either saphenous venous reflux alone or in combination with deep venous reflux. Methods Ambulatory venous pressure was measured in 16 legs with saphenous vein reflux alone and in nine legs with combined d eep and saphenous venous reflux before, immediately after and 3 months after saphenofemoral or popliteal disconnection. Ulcer area was measu red by computerized planimetry before surgery and at 1 and 3 months af ter operation. No compression bandages or hose were applied after surg ery unless the ulcers had not begun to heal after 1 month. Results In legs with saphenous reflux alone all ulcers healed without compression bandages at a median of 81 (range 14-253) days and the pressure relie f index (PRI) improved significantly both after surgery and at follow- up. None of the ulcers in the nine limbs with saphenous and deep venou s reflux healed without compression bandaging and the PRI was unchange d immediately following surgery and at follow-up. Conclusion Saphenous vein disconnection improves venous function and heals venous ulcers w ithout compression bandaging if the deep veins are normal. This proced ure under local anaesthetic may be particularly suitable for elderly p atients, but long saphenous vein stripping should be added in young pa tients.