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[The role of perforating vein dissection in the treatment concept of venous ulcers--myths and evidence].
Vasa. 2002 Nov; 31(4):225-9.VASA

Abstract

Crural ulcers represent the most serious form of chronic venous incompetence (CVI). According to duplex studies superficial venous incompetence predominate in this stage of the disease, but combined refluxes of superficial and deep veins are also common. Despite a positive correlation between the number of incompetent perforators and the stage of CVI isolated incompetence of perforating veins in venous ulcers are rarely found. Additionally, only a minority of incompetent perforators depict larger reflux volumes. Therefore, doubts about a causal role of perforators incompetence in ulcer genesis are justified. According to phlebodynamometric studies the risk of crural ulcer development increases with the degree of hemodynamic compromise. Ulcer healing can only be achieved after complete normalization of ambulatory venous hypertension. In case of superficial refluxes and concomitant incompetence of perforating veins exclusion of the superficial component is sufficient to achieve this goal. Incompetent perforators normalize their function consecutively. In contrast, venous hypertension persists after exclusion of superficial refluxes in case of incompetent perforators and irreversible damage of the deep venous system. Surgical therapy studies exactly reflect the results of these hemodynamic examinations. Therefore, the role of endoscopic subfascial perforator dissection (ESPD) in the treatment of venous ulcers remains unclear. Future therapy studies should take into account that the definite role of ESPD in ulcer healing can only be examined without additional treatment of refluxes in the saphena system. Additionally, all study patients should be classified according to the CEAP nomenclature and Hach's classification of chronic compartment syndrome. Methodological differences in technique and extent of ESPD have also to be taken into account.

Authors+Show Affiliations

Klinische Abteilung für Gefässchirurgie der Universitätsklinik für Chirurgie, Innsbruck, Osterreich. p.klein-weigel@ruppiner-kliniken.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

ger

PubMed ID

12510545

Citation

Klein-Weigel, P, et al. "[The Role of Perforating Vein Dissection in the Treatment Concept of Venous Ulcers--myths and Evidence]." VASA. Zeitschrift Fur Gefasskrankheiten, vol. 31, no. 4, 2002, pp. 225-9.
Klein-Weigel P, Biedermann H, Fraedrich G. [The role of perforating vein dissection in the treatment concept of venous ulcers--myths and evidence]. Vasa. 2002;31(4):225-9.
Klein-Weigel, P., Biedermann, H., & Fraedrich, G. (2002). [The role of perforating vein dissection in the treatment concept of venous ulcers--myths and evidence]. VASA. Zeitschrift Fur Gefasskrankheiten, 31(4), 225-9.
Klein-Weigel P, Biedermann H, Fraedrich G. [The Role of Perforating Vein Dissection in the Treatment Concept of Venous Ulcers--myths and Evidence]. Vasa. 2002;31(4):225-9. PubMed PMID: 12510545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [The role of perforating vein dissection in the treatment concept of venous ulcers--myths and evidence]. AU - Klein-Weigel,P, AU - Biedermann,H, AU - Fraedrich,G, PY - 2003/1/4/pubmed PY - 2003/3/26/medline PY - 2003/1/4/entrez SP - 225 EP - 9 JF - VASA. Zeitschrift fur Gefasskrankheiten JO - Vasa VL - 31 IS - 4 N2 - Crural ulcers represent the most serious form of chronic venous incompetence (CVI). According to duplex studies superficial venous incompetence predominate in this stage of the disease, but combined refluxes of superficial and deep veins are also common. Despite a positive correlation between the number of incompetent perforators and the stage of CVI isolated incompetence of perforating veins in venous ulcers are rarely found. Additionally, only a minority of incompetent perforators depict larger reflux volumes. Therefore, doubts about a causal role of perforators incompetence in ulcer genesis are justified. According to phlebodynamometric studies the risk of crural ulcer development increases with the degree of hemodynamic compromise. Ulcer healing can only be achieved after complete normalization of ambulatory venous hypertension. In case of superficial refluxes and concomitant incompetence of perforating veins exclusion of the superficial component is sufficient to achieve this goal. Incompetent perforators normalize their function consecutively. In contrast, venous hypertension persists after exclusion of superficial refluxes in case of incompetent perforators and irreversible damage of the deep venous system. Surgical therapy studies exactly reflect the results of these hemodynamic examinations. Therefore, the role of endoscopic subfascial perforator dissection (ESPD) in the treatment of venous ulcers remains unclear. Future therapy studies should take into account that the definite role of ESPD in ulcer healing can only be examined without additional treatment of refluxes in the saphena system. Additionally, all study patients should be classified according to the CEAP nomenclature and Hach's classification of chronic compartment syndrome. Methodological differences in technique and extent of ESPD have also to be taken into account. SN - 0301-1526 UR - https://www.unboundmedicine.com/medline/citation/12510545/[The_role_of_perforating_vein_dissection_in_the_treatment_concept_of_venous_ulcers__myths_and_evidence]_ L2 - https://econtent.hogrefe.com/doi/10.1024/0301-1526.31.4.225?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -