VENOUS ULCERATION AND SAPHENOUS LIGATION

Over an 8-year period a prospective series of 213 consecutive patients with venous ulceration of 232 limbs has been studied. By means of clinical, hand-held Doppler ultrasound and comprehensive ascending and descending venography examination, it was possible to identify underlying morphological abnormalities and on the basis on these to divide patients into four principal types. Type I: 4%-ankle perforator incompetence alone; Type II: 39%-ankle perforator and saphenous incompetence; Type III: 35%-primary deep incompetence (usually associated with perforator and saphenous incompetence); Type IV: 22%-patients with postphlebitic damage. This study reports the outcome of Type II patients that have been treated by saphenous ligation alone (no perforator ligation). Healing was maintained over a mean period of 3.5 years in all but five patients. In these, other factors were shown in retrospect to be contributory to failed healing. It is concluded, therefore, that approximately 40% of venous ulcers can be ascribed to a combination of incompetence of saphenous and ankle perforating veins and that medium-term healing can be achieved in at least 90% of these by saphenous ligation alone.