RESULTS COMPARING COMPRESSION ALONE VERSUS COMPRESSION AND SURGERY IN TREATING VENOUS ULCERATION

Publisher Summary This chapter discusses the results comparing compression alone versus compression and surgery in treating venous ulceration. Chronic venous ulceration is widely accepted as a common, debilitating, and expensive health problem. Although most patients have superficial venous incompetence potentially amenable to surgical correction, evidence to support operative intervention has been scarce. Other researches strongly suggest that superficial venous surgery reduces venous ulcer recurrence and should be considered for all patients with chronic venous ulceration. Patients deemed suitable for surgical treatment should undergo color duplex venous mapping in order to identify superficial venous incompetence potentially suitable for surgical correction. Although the advantage appears greatest for legs with isolated superficial reflux, surgery may also reduce ulcer recurrence for some patients with deep venous incompetence, and hemodynamic assessment may be a useful selection tool. Despite any proven clinical benefit, it must be acknowledged that elderly patients with leg ulcers may be unfit for surgical intervention or unwilling to accept it. Local anesthetic surgery was performed in a quarter of patients, but long-term effectiveness is unlikely to match general anesthetic procedures. Residual venous reflux after venous surgery was common, although this was not associated with reduced hemodynamic function or clinical outcomes.