Calf pump function in patients with healed venous ulcers is not improved by surgery to the communicating veins or by elastic stockings

Abstract

Calf muscle pump function was assessed in 41 limbs after venous ulcers had healed. Treatment was then randomized either to ligation of incompetent lower leg communicating veins and ablation of incompetent superficial veins combined with permanent graduated compression elastic stockings, or to graduated compression elastic stockings only. Half volume refilling time (TV1/2) and relative expelled volume (EVrel) measured on foot volume plethysmography were used to assess calf muscle pump function. This was repeated after 12 months. The initial TV1/2 and EVrel were significantly lower than for normal limbs. There was no significant improvement in TV1/2 in either treatment group (Student's t test, P = 0.78, P = 0.19). EVrel did not improve significantly in limbs treated with elastic stockings alone (P = 0.94), but there was a slight but significant improvement in EVrel in limbs treated with surgery and elastic stockings (P = 0.048); however, this was still significantly below the normal range (P less than 0.001). In limbs without phlebographic evidence of post-thrombotic changes, treated with the combination of surgery and elastic stockings, there was a significant improvement in EVrel (P = 0.035), but no improvement was found in limbs with post-thrombotic changes. This small but significant improvement in EVrel in limbs without post-thrombotic changes treated by surgery and elastic stockings may explain the reduced incidence of reulceration that has been found following surgical eradication of the superficial and communicating veins.

Ultrasound-Guided Injection of Polidocanol Microfoam in the Management of Venous Leg Ulcers

“…A recent study found that 50% of incompetent perforators within 10 cm of the sole of the foot, identified preoperatively by duplex ultrasound, were missed at subfascial endoscopy. 22 Small interconnected collaterals between the perforators and the skin frequently convey the VH to the skin area, and surgical procedures are inherently unable to close these vessels. Thus, small interconnected collaterals can often remain open after surgical closure of the perforator, probably leading to a new increase in venous pressure and eventual recurrence of the ulcer.…”

Incompetent perforating veins of the foot

“…The anatomy of perforating veins in the leg, pathophysiology and hemodynamic significance in chronic venous insufficiency have been discussed frequently in the past. [1,2,3,4,5,6,7].…”

Calf Perforating Veins – Time for an Objective Appraisal?

“…In a subsequent series of similar patients studied prospectively, no improvement in functional indices was shown following perforating vein surgery [2]. From these data it must be concluded that perforating vein surgery is probably inappropriate in patients with deep vein incompetence.…”