INTRODUCTION. Treatment of venous ulcerations should be based on
etiopathogenetic characteristics. Previous biochemical, histological and
clinical investigations show that there are two types of venous ulcerations:
caused by superficial venous insufficiency (SU) and by deep venous
insufficiency or obstruction (DU). Both types include communicative
(perforate) vein incompetence. Different procedures are used to block
pathological blood reflux and they depend on the type of ulceration.
OBJECTIVE. Aim of the study was to evaluate short-term and long-term
follow-up of different surgical procedures in superficial, communicant and
deep veins that depend on the type of ulceration. METHOD. Patients with
venous ulcerations are divided into two groups: C5-6EpsAspPr (equivalent to
SU) and C5-6EpsAdpPro (equivalent to DU) according to CEAP classification. In
the first group operative treatment involved superficial and perforating
veins, and in the second group operative treatment involved deep and
perforating veins. We used ?2 test to compare the groups. RESULTS. Venous
ulcerations are more often in women (59.1%) than men (40.9%), on the average
in their late sixties. Clinical signs of venous stasis and trophic changes
are more often in DU than SU. Patients with SU were operatively treated on
superficial (136 partial or complete stripping of main veins), communicating
(25 ligatures, 22 subfascial shearing) or by combined procedures on
superficial and communicating veins (80). Patients with DU were operatively
treated by perforator?s ligature (17), subfascial perforator?s shearing (12),
superficial vein operations (4), sapheno-popliteal anastomoses (18), de Palma
bypass (13) and interposition of healthy saphena segment (1). Long-term
follow-up was registered after 5-15 (on average 3.7) years in 75 (58 SU and
17 DU) patients. Relapse of ulcerations were detected in 9 (15.5%) SU and 3
(17.6%) DU, i.e. (16.0%) of all operated patients with venous ulcers.
CONCLUSION. In patients undergoing surgery for chronic venous insufficiency
(2.274) more often present with SU (263) than DU (65). Patients with DU had
more significant trophic changes and pathological blood reflux that required
reconstructive procedures of deep veins. CEAP classification is equivalent to
etiopathogenetic types of venous ulcerations and it is appropriate for
follow-up of clinical characteristics and results of venous ulceration
treatment.
Long-term follow-up of lung transplant recipients supports non-operative treatment of uncomplicated diverticulitis
