Role of arteriovenous shunting in venous ulcers - Therapeutic implications

Although the presence of arteriovenous communications in patients with chro nic venous ulcers has been confirmed in several studies, their role in the pathogenesis of venous ulcers is still uncertain. They possibly do play an important role in the aetiology of chronic venous insufficiency. There is a lso substantial evidence to suggest that arteriovenous communications devel op as a result of chronic venous hypertension. The question raised in this pilot study was whether the importance of arteriovenous shunts In the genes is of venous ulcer disease is such that their obliteration might lead to lo ng-term healing. This clinical study was also designed to determine whether therapeutic microembolization of nutritive arterial branches to arterioven ous fistulas, found In patients with venous ulcers, facilitates healing of venous ulcers resistant to previous conservative and/or classical surgical treatment. From 1997 to 1999, 34 patients (22 women and 14 men, mean age 51 .3 years) with chronic venous ulcer resistant to classical treatment were i ncluded in the study. Arteriovenous shunting was demonstrated by digital su btraction angiography in 31 patients (31/34 = 91 %). The embolization proce dure of muscular arterial branches feeding the arteriovenous shunts with mi crospirals and microparticles led to ulcer healing in 13 patients (13/31). The results suggest that the role of arteriovenous shunting in chronic veno us ulceration resistant to classical treatment is more important than previ ously suggested, and that their microembolization might lead to complete he aling.