COLOR DUPLEX ULTRASOUND IN THE ASSESSMENT OF PRIMARY VENOUS LEG ULCERATION

METHODS. To determine the extent and severelity of venous reflux, colo r duplex ultrasound was used in 370 limbs of 303 patients with primary varicose veins. The clinical findings were classified according to th e CEAP (clinical, etiologic, anatomic, pathophysiologic) clinical clas sification. RESULTS. Of 370 limbs, 32 showed previously healed ulcer ( Class 5) and active ulcer (Class 6). Overall reflux in the superficial venous system was seen in 28 limbs (87.5%), and solitary superficial vein incompetence was detected in 13 (40.6%). Reflux was detected thro ughout the length of the superficial vein system, and the retrograde p eak velocity was greater than 30 cm/second in these limbs. Reflux in t he perforating veins was detected in 14 limbs (43.8%), but isolated pe rforating vein incompetence was seen in only one limb (3.1%). Deep vei n incompetence was detected in 12 limbs (37.5%). Concomitant superfici al and perforating vein reflux was evident in 4 limbs (12.5%) and 2 li mbs (6.3%), respectively, but isolated deep vein incompetence was dete cted in only one limb (3.1%). The operations indicated were selective stripping of the long saphenous vein in the thigh, high ligation of th e short saphenous vein, subfascial ligation of perforating veins, and compression sclerotherapy for varicose tributary veins. Healing of the ulcers was achieved within 1 month after surgery, and the postoperati ve color duplex scanning revealed correction of deep vein incompetence . CONCLUSIONS. These data suggest that ablation of the superficial vei n system and the perforating veins is an appropriate method for the ma nagement of patients with primary venous leg ulceration. (C) 1998 by t he American Society for Dermatologic Surgery, Inc.