Clinical study on management of venous ulcer
Keywords:Chronic venous ulcer, Sapheno-femoral junction, Short saphanous vein, Great saphanous vein
Background: Venous ulcer is the most common ulcer affecting the lower limbs, usually associated with varicose veins. They are diagnosed by their location, morphology, skin changes, and association with venous insufficiency. They are complicated with local scarring, ankylosis of ankle joint, and occasionally malignancy. Diagnosis is confirmed by venous duplex imaging. They significantly reduce quality of life due to pain, and reduced mobility leading to loss of income and social isolation. Cost estimates put them at upwards of 2% of national resources. Recurrence is high with conservative treatment. Surgery addressing venous valvular insufficiency plays a major role. Objectives of current study was to assess the role of conservative treatment and surgical management of venous ulcers.
Methods: A cross-sectional study of 80 patients in the period 2019 -2020 at a tertiary care center.
Results: 84% of the patients were male with maximum patients in the 6th decade. 67% were overweight. Conservative treatment was done in 22% of cases and surgery for 78%. Flush ligation and venous stripping with perforator ligation was the most common surgery done. 89% of the patients achieved healing by the end of 3 months, and 7% by the end of 6 months. Wound healing time in surgical vs conservatively was 8.3 and 10.4 weeks respectively.
Conclusions: Correction of underlying venous insufficiency is the main stay of the treatment. Surgery gives best results with long term benefits.
Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Physician. 2010;81(8):989-96.
Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers. 2013:1-9.
Nicolaides AN, Hussein MK, Szendro G, Christopoulos D, Vasdekis S, Clarke H. The relationship of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg. 1993; 17:414-9.
Trent JT, Falabella A, Eaglstein WH, Kirsner RS.Venous ulcers: pathophysiology and treatment options. Ostomy Wound Manage. 2005;51:38-54.
Wittens CD, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, et al. Management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015;49(6):678-737.
Chattarjee SS. Venous ulcers of the lower limb: Where do we stand? Indian J Plast Surg. 2012;45(2): 266-274
O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;11:CD000265.
Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev. 2012;12:CD001733.
Nicolaides A, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P, et al. Management of chronic venous disorders of the lower limbs-guidelines according to scientific evidence. Int Angiol. 2014;33(2):87-208.
Howard DP, Howard A, Kothari A, Wales L, Guest M, Davies AH. The role of superficial venous surgery in the management of venous ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2008; 36(4):458-65.
Raju S, Fredericks RK, Negelen PN, Bass JD.Durability of venous valve reconstruction techniques for “primary” and postthromboticrefl ux. J Vasc Surg. 1996;23:357-67.
Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radio-frequency ablation, foam sclerotherapy and surgical stripping for great Saphenous varicose veins. Br J Surg. 2011;98:1079-87.
Dekiwadia DB, Jindal R, Varghese R, Bedi HS, Padaria S, Patel MD, et al. Executive summary: a consensus statement-part I: recommendations for the management of chronic venous disease (CVD) in India and key role of primary care doctors. J Assoc Physicians India. 2016;64(8):53-6.
Ramamoorthy P. The growing threat of chronic venous disease. New Delhi; Jaypee Brothers Medical Publishers Pvt Ltd: 2013;753-6.
Rao BN, Pusphalatha R. A clinical study on varicose veins of lower limb, surgical management and functional outcome at a tertiary care hospital of South India. Int Surg J. 2020;7:1051-5.
Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Nikishkov AS, Tatarintsev AM, Kirienko AI. Prevalence and Risk Factors for Chronic Venous Disease in the General Russian Population. Eur J Vasc Endovasc Surg. 2017;54(6): 752-8.
Sukumaran C, Matad S, Parambil SM, Navas NK. Pattern of presentation of chronic venous insufficiency in a tertiary centre and corelation of disease severity with duplex findings. Indian J App Res. 2017;7(10):45-9.
Criqui MH, Jamosmos M, Fronek A, Denenberg JO, Langer RD, Bergan J, et al. Chronic venous disease in an ethnically diverse population: the San Diego Population Study. Am J Epidemiol. 2003;158(5): 448-56.
Baker SR, Stacey MC, Jopp-McKay AG, Hoskin SE, Thompson PJ. Epidemiology of chronic venous ulcers. Br J Surg. 1991;78(7):864-7.
Patra S. Presentations, complications and approaches to varicose veins- a clinical study. IOSR J Dent Med Sci. 2019;18(2):62-7.
Dheepak S, Kota A, Prabhu P, Stephen E, Agarwal S. Socio-demography and clinical profile of venous ulcers presenting to a tertiary hospital in South India. Wound Med. 2017;12:45-9.
Suehiro K, Morikage N, Yamashita O, Harada T, Samura M, Takeuchi Y, et al. Factors in patients with venous stasis- related skin lesions without major abnormalities on duplex ultrasonography. Ann Vasc Dis. 2016;9(3):201-4.
Stvrtinova V, Kolesar J, Wimmer G. Prevalence of varicose veins of the lower limbs in the women working at a department store. Int Angiol. 1991; 10:2-5.
Maffei FH, Magaldi C, Pinho SZ, Lastoria S, Pinho W, Yoshida WB, Rollo HA. Varicose veins and chronic venous insufficiency in Brazil: prevalence among 1755 inhabitants of a country town. Int J Epidemiol. 1986;15(2):210-7.
Reddy M, Naik M. A study on varicose veins cases attending to Government General Hospital, Anantapur. Asian Pacific J Health Sci. 2017;4:182-5.
Samane D, Swami G, Chandrashekhar S, Takalkar A. Clinical profile of patients with varicose vein: a cross sectional study from Vilasrao Deshmukh Institute of Medical Sciences, Latur, Maharashtra. Int Sur J. 2020;7(8):2691-5.
Kumar G, Dattatreya C, Naik M. Study on clinical profile and management of varicose veins of lower limbs. Int Surg J. 2019;6(4):1097-3.
Lawrence PF, Hager ES, Harlander-Locke MP, Pace N, Jayaraj A, Yohann A, et al. Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers. J Vasc Surg Venous Lymphat Disord. 2020; 8(4):601-9.
Swami G. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ. 2007;335(7618):40.
Nelzén O, Fransson I. True long-term healing and recurrence of venous leg ulcers following SEPS combined with superficial venous surgery: a prospective study. Eur J Vasc Endovasc Surg. 2007; 34(5):605-12.
Ahmed MS, Srinivas PAI. Varicose veins: a clinical study. Int Surg J. 2017;4(2):529-33.
van Gent WB, Hop WC, van Praag MC, Mackaay AJ, de Boer EM, Wittens CH. Conservative versus surgical treatment of venous leg ulcers: a prospective, randomized, multicenter trial. J Vasc Surg. 2006;44(3):563-71.