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Identifying the source of superficial reflux in venous leg ulcers using duplex ultrasound.
J Vasc Surg. 2010 Nov; 52(5):1255-61.JV

Abstract

OBJECTIVE

Mapping of venous reflux routes associated with medially or laterally located venous leg ulcers and their source of origin.

METHODS

This prospective report presents the results of duplex investigations performed in consecutive leg ulcer patients, all with venous reflux, in a time period over 2 years. A total of 169 patients (183 legs), with chronic venous leg ulcers (CEAP: C6) were examined in a private practice. The data collection integrated an examination that included medical history and clinical diagnoses and incorporated measurements such as body mass index, oscillometric index, and range of motion of the ankle joint. Venous function was assessed with duplex ultrasound, and the cases were described using the advanced CEAP classification. Additionally, a "sourcing" technique was performed with duplex ultrasound investigation of the ulcer bed and the venous system under manual compression and release of the ulcer. The principle of "sourcing" is to follow venous reflux from the ulcer area to its proximal origin. The detected reflux routes were classified either as "axial" or "crossover" type.

RESULTS

A total of 20% of the ulcer patients showed no clinically visible varicose veins. One hundred three patients had medial ulcers, 54 lateral ulcers, 21 medial and lateral, and five had gaiter ulcers. Sixty-four (35%) of the medially located ulcers had reflux in the great saphenous vein (GSV), 28 (15%) showed reflux in the medial perforating veins (axial types), and 11 (6%) had reflux in the small saphenous vein (SSV; crossover type). From 54 patients presenting with lateral ulcers, 25 (14%) showed GSV incompetence (crossover type) and only 13 (7%) SSV incompetence (axial type). Sixteen patients showed refluxes penetrating from deep into lateral perforating veins.

CONCLUSION

Crossover reflux routes were detected in 25 of 54 (46%) legs with lateral and in 11 of 103 (11%) legs with medial ulceration (χ2 44.34; P<.001). In venous ulcer patients, an extended examination (CEAP classification) and a special duplex technique ("sourcing") are recommended to identify the specific route responsible for the venous reflux. This seems essential for planning a rational treatment of venous reflux ulcers.

Authors+Show Affiliations

Institute of Functional Phlebologic Surgery, Karl Landsteiner Society, Melk, Austria. obermayer@focusvena.atNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20692796

Citation

Obermayer, Alfred, and Katharina Garzon. "Identifying the Source of Superficial Reflux in Venous Leg Ulcers Using Duplex Ultrasound." Journal of Vascular Surgery, vol. 52, no. 5, 2010, pp. 1255-61.
Obermayer A, Garzon K. Identifying the source of superficial reflux in venous leg ulcers using duplex ultrasound. J Vasc Surg. 2010;52(5):1255-61.
Obermayer, A., & Garzon, K. (2010). Identifying the source of superficial reflux in venous leg ulcers using duplex ultrasound. Journal of Vascular Surgery, 52(5), 1255-61. https://doi.org/10.1016/j.jvs.2010.06.073
Obermayer A, Garzon K. Identifying the Source of Superficial Reflux in Venous Leg Ulcers Using Duplex Ultrasound. J Vasc Surg. 2010;52(5):1255-61. PubMed PMID: 20692796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying the source of superficial reflux in venous leg ulcers using duplex ultrasound. AU - Obermayer,Alfred, AU - Garzon,Katharina, Y1 - 2010/08/08/ PY - 2010/04/07/received PY - 2010/06/02/revised PY - 2010/06/04/accepted PY - 2010/8/10/entrez PY - 2010/8/10/pubmed PY - 2010/12/14/medline SP - 1255 EP - 61 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 52 IS - 5 N2 - OBJECTIVE: Mapping of venous reflux routes associated with medially or laterally located venous leg ulcers and their source of origin. METHODS: This prospective report presents the results of duplex investigations performed in consecutive leg ulcer patients, all with venous reflux, in a time period over 2 years. A total of 169 patients (183 legs), with chronic venous leg ulcers (CEAP: C6) were examined in a private practice. The data collection integrated an examination that included medical history and clinical diagnoses and incorporated measurements such as body mass index, oscillometric index, and range of motion of the ankle joint. Venous function was assessed with duplex ultrasound, and the cases were described using the advanced CEAP classification. Additionally, a "sourcing" technique was performed with duplex ultrasound investigation of the ulcer bed and the venous system under manual compression and release of the ulcer. The principle of "sourcing" is to follow venous reflux from the ulcer area to its proximal origin. The detected reflux routes were classified either as "axial" or "crossover" type. RESULTS: A total of 20% of the ulcer patients showed no clinically visible varicose veins. One hundred three patients had medial ulcers, 54 lateral ulcers, 21 medial and lateral, and five had gaiter ulcers. Sixty-four (35%) of the medially located ulcers had reflux in the great saphenous vein (GSV), 28 (15%) showed reflux in the medial perforating veins (axial types), and 11 (6%) had reflux in the small saphenous vein (SSV; crossover type). From 54 patients presenting with lateral ulcers, 25 (14%) showed GSV incompetence (crossover type) and only 13 (7%) SSV incompetence (axial type). Sixteen patients showed refluxes penetrating from deep into lateral perforating veins. CONCLUSION: Crossover reflux routes were detected in 25 of 54 (46%) legs with lateral and in 11 of 103 (11%) legs with medial ulceration (χ2 44.34; P<.001). In venous ulcer patients, an extended examination (CEAP classification) and a special duplex technique ("sourcing") are recommended to identify the specific route responsible for the venous reflux. This seems essential for planning a rational treatment of venous reflux ulcers. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/20692796/Identifying_the_source_of_superficial_reflux_in_venous_leg_ulcers_using_duplex_ultrasound_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(10)01459-X DB - PRIME DP - Unbound Medicine ER -