Nonostante i recenti progressi in tema di wound care, le ulcere varicose degli arti inferiori restano un problema frequente, con un alto tasso di recidiva. In questo lavoro abbiamo esaminato la storia clinica, la storia chirurgica e le patologie associate di 133 pazienti affetti da ulcera varicosa degli arti inferiori, di cui 56 da ulcera recidiva o plurirecidiva. L’analisi dei fattori di rischio potenziale per recidiva ha evidenziato come la presenza di varici recidive, una pregressa trombosi venosa profonda, problemi ortopedici, interventi ortopedici, l’obesità e un’età inferiore a 60 anni siano fattori di rischio potenziale per una recidiva dell’ulcera. La combinazione di uno più fattori di rischio assume significatività per la possibilità di una recidiva; si passa dal 22,7% in assenza di fattori di rischio al 33% per i pazienti che ne presentano due, fino al 57,5% in presenza di tre fattori di rischio e all’81,3% per quattro o più. L’ulcera varicosa richiede un follow-up stretto del paziente e una terapia elastocompressiva continua, che deve vedere una stretta collaborazione del paziente e un’attenzione specifica ai fattori di rischio. Despite recent advances in wound care, varicose ulcers of lower limbs remain frequent and display a high rate of recurrence. In this paper, we examined the clinical, surgical histories and associated diseases of 133 patients with venous ulcers of the lower limbs, which were recurrent in 56 cases. The analysis of potential risk factors for recurrence showed that the presence of recurrent varicose veins, a previous deep venous thrombosis, orthopedic problems, previous orthopedic procedures, obesity and age lower than 60 are potential risk factors for ulcer recurrence. Furthermore, the association of one or more risk factors increased the likelihood of relapse, from 22.7% with no risk factors to 33% with 2 risk factors, up to 57.5% with 3 risk factors, and up to 81.3% with 4 risk factors or more. Venous ulcers require close follow-up and continuous elastic compression, close collaboration by the patient and specific focus on risk factors.

Venous ulcers (VUs) of lower limbs affect 1% of Western population. In most cases, ultrasounds show only superficial venous insufficiency (SVI), but a deep venous insufficiency (DVI) may also be present without a history of deep vein thrombosis (DVT). To assess SVI and DVI in DVT-positive and DVT-negative patients with VU, a retrospective cohort of 123 patients entered the study (50 male and 73 female, minimum age 29 years and maximum age 90 years, and mean 70.6 years). In 56 patients (45.5%), ulcer was on the right leg, in 52 (42.3%) on the left leg, and in 15 patients (12.2%), ulcer was bilateral, resulting in a total number of 138 limbs in the study. Sixty-six patients suffered DVT, while in 72 anamnesis was negative. Color duplex ultrasound was performed on both limbs, which revealed insufficiencies of superficial and/or deep veins in 18 limbs which had not been affected by an ulcer or a previous DVT. So the study was on 156 limbs. SVI were substantially overlapping in two groups (p-value = 0.593), while combined SVI and DVI was 72.5% in DVT positive limbs (p-value = 0.001). In 70% of cases with a femoral vein insufficiency (p-value = 0.036) or popliteal vein insufficiency (PVI) (p-value 0,003), a DVT history was present. Of 18 limbs, although not affected by ulcer or previous DVT, eight were positive for DVI (two femoral veins and six popliteal veins). In the patient with VU, the history of DVT is a strong predictor of DVI insufficiency. In DVT-positive patients with ulcer, the number of “combined superficial and deep insufficiencies” appears to be particularly significant and surgical treatment must take this into account. A previous DVT has a low impact on great and small saphenous insufficiencies in ulcer patients; these were substantially overlapping in DVT-positive and DVT-negative patients. The 18 limbs with DVI and SVI without ulcer and DVT history were unexpected result. We think these patients must have a close follow-up to avoid the onset of a VU.

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