Current concepts in chronic venous ulceration

Objectives: despite numerous reports on the distribution of reflux in patie nts with venous ulceration, there is no consensus on the contribution of ea ch venous system. This study was performed to evaluate the distribution of reflux in this group of patients. Methods: a literature search from 1980 to 1998 was performed. Because duple x scanning is the best method for detecting venous reflux, we only included reports that used this diagnostic modality. All studies with less than 30 ulcerated limbs were excluded. Since most reports did not give detailed dat a on perforator veins, reflux in these veins tons combined with the superfi cial and deep veins. Documented episodes of superficial or deep vein thromb osis were noted. Results: thirteen studies that included 1249 ulcerated limbs fulfilled the inclusion criteria. The mean age of patients was 59 years (95% CI:54-63, ra nge: 14-93). Reflux was detected in 1153 (92%) of limbs. Reflux confined to the superficial veins alone was seen in 45% of limbs, in the deep veins al one in 12% and in both the superficial and deep veins in 43% of limbs. The overall involvement of the superficial veins was 88% and of the deep veins 56% (p < 0.0001). A documented episode of deep vein thrombosis was reported in only six of the 13 studies and the incidence was found to be 32%. Conclusions: reflux in the superficial veins is seen in 88% of limbs with v enous ulcers (CEAP classes 5 and 6). Isolated superficial vein incompetence is detected in 45%, while reflux in the deep venous system alone is seen i n only 12%. These data have significant clinical implications, since reflux in the superficial system can be easily eliminated by excision of the affe cted veins.