Does the Correction of Insufficient Superficial and Perforating Veins Improve Venous Function in Patients with Deep Venous Insufficiency?

Abstract

Thirty limbs in 25 patients with chronic deep venous insufficiency and recurrent ulceration were examined by ascending and descending contrast phlebography, occlusion plethysmography, foot volumetry and ambulatory venous pressure. Superficial venous insufficiency was surgically corrected by stripping of the saphenous vein and local excision of the varicosities (op1) in 12 limbs. Perforating venous insufficiency was then corrected by extensive subfascial ligation of perforating veins (op2) in all limbs. Venous outflow capacity, measured by occlusion plethysmography, and muscle pump function, measured by foot volumetry, were not affected by either procedure. Venous reflux, measured by foot volumetry, (Q/EVrel) and by venous pressure return time (RT90) improved significantly with op1 but no change was seen after op2. Venous hypertension decreased significantly with op1 but did not change after op2, and 59% of the limbs still had severe venous hypertension (> 60 mmHg) after both procedures. Initial clinical results were good, ulcers persisting in only three limbs, but recurrences occurred in an additional six limbs within 27 months. The limbs with persistent or recurrent ulcers had severe phlebographic reflux and severe venous hypertension. These results demonstrate that improvement in venous reflux and hypertension may be achieved by correction of superficial venous insufficiency, but the addition of ligation of perforating veins seems to be of less benefit to the venous circulation.