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The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers.
Surgery. 1977 Jul; 82(1):9-14.S

Abstract

To investigate the possible anatomic and hemodynamic reasons for the variability in response to surgery for venous insufficiency (a 50% ulcer recurrence rate following ligation of incompetent perforating veins), we performed phlebography and venous pressure measurements in 109 legs of 77 patients and in 30 healthy volunteers. Patients were divided into five groups: saphenofemoral incompetence alone (group 1), saphenopopliteal incompetence (group 2), incompetent lower leg communicating veins alone (group 3), calf communicating veins and saphenous incompetence (group 4), and postthrombotic limbs (group 5). Patients in groups 1 through 4 had phlebographically normal deep veins. As compared to the normal controls (68%), preoperative pressure measurements revealed a significantly smaller pressure fall during exercise (deltaVPex) in all groups, which was the least marked in groups 3 (26%) and 5 (17%). These latter two groups failed to increase their pressure fall with thigh tourniquet. deltaVPex 3 months after operation demonstrated normalization in groups 1, 2, and 4 (52%, 57% and 59% respectively). Groups 3 and 5 improved little following surgical ligation. Whenever saphenous vein incompetence coexists with lower leg communicating vein incompetence, the former appears to be the dominant cause of the pressure abnormalities. Based on venous pressure measurements and phlebography, patients with normal deep veins and who increase their deltaVPex with a thigh tourniquet should respond favourably to orthodox surgical ligation of the saphenofemoral or saphenopopliteal junction. By contrast, if no change in deltaVPex is noted in patients with incompetent perforating veins and the deep veins look abnormal on the phlebogram, then ligation of the incompetent communicating veins would appear to be associated with a high recurrence rate.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

877859

Citation

Burnand, K G., et al. "The Relative Importance of Incompetent Communicating Veins in the Production of Varicose Veins and Venous Ulcers." Surgery, vol. 82, no. 1, 1977, pp. 9-14.
Burnand KG, O'Donnell TF, Thomas ML, et al. The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. Surgery. 1977;82(1):9-14.
Burnand, K. G., O'Donnell, T. F., Thomas, M. L., & Browse, N. L. (1977). The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. Surgery, 82(1), 9-14.
Burnand KG, et al. The Relative Importance of Incompetent Communicating Veins in the Production of Varicose Veins and Venous Ulcers. Surgery. 1977;82(1):9-14. PubMed PMID: 877859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. AU - Burnand,K G, AU - O'Donnell,T F,Jr AU - Thomas,M L, AU - Browse,N L, PY - 1977/7/1/pubmed PY - 2001/3/28/medline PY - 1977/7/1/entrez SP - 9 EP - 14 JF - Surgery JO - Surgery VL - 82 IS - 1 N2 - To investigate the possible anatomic and hemodynamic reasons for the variability in response to surgery for venous insufficiency (a 50% ulcer recurrence rate following ligation of incompetent perforating veins), we performed phlebography and venous pressure measurements in 109 legs of 77 patients and in 30 healthy volunteers. Patients were divided into five groups: saphenofemoral incompetence alone (group 1), saphenopopliteal incompetence (group 2), incompetent lower leg communicating veins alone (group 3), calf communicating veins and saphenous incompetence (group 4), and postthrombotic limbs (group 5). Patients in groups 1 through 4 had phlebographically normal deep veins. As compared to the normal controls (68%), preoperative pressure measurements revealed a significantly smaller pressure fall during exercise (deltaVPex) in all groups, which was the least marked in groups 3 (26%) and 5 (17%). These latter two groups failed to increase their pressure fall with thigh tourniquet. deltaVPex 3 months after operation demonstrated normalization in groups 1, 2, and 4 (52%, 57% and 59% respectively). Groups 3 and 5 improved little following surgical ligation. Whenever saphenous vein incompetence coexists with lower leg communicating vein incompetence, the former appears to be the dominant cause of the pressure abnormalities. Based on venous pressure measurements and phlebography, patients with normal deep veins and who increase their deltaVPex with a thigh tourniquet should respond favourably to orthodox surgical ligation of the saphenofemoral or saphenopopliteal junction. By contrast, if no change in deltaVPex is noted in patients with incompetent perforating veins and the deep veins look abnormal on the phlebogram, then ligation of the incompetent communicating veins would appear to be associated with a high recurrence rate. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/877859/The_relative_importance_of_incompetent_communicating_veins_in_the_production_of_varicose_veins_and_venous_ulcers_ L2 - https://antibodies.cancer.gov/detail/CPTC-HLA-B-1 DB - PRIME DP - Unbound Medicine ER -