Aditi M Kanth1, Sami U Khan2, Antonis Gasparis2, Nicos Labropoulos2. 1. Department of Surgery, Division of Vascular Surgery, SUNY at Stony Brook, Stony Brook, NY, USA Aditi.kanth88@gmail.com. 2. Department of Surgery, Division of Vascular Surgery, SUNY at Stony Brook, Stony Brook, NY, USA.
Abstract
OBJECTIVES: This study was performed to precisely define the underlying pathophysiology in patients with active venous ulcers. METHODS: A PubMed search was conducted from 1991 to 2013 to select papers reporting the anatomic and physiologic etiology of ulceration in CEAP Class 6 patients. Studies which did not decipher between active and healed ulcers, did not use clear definitions, or did not give detailed accounts on the distribution/extent of venous pathology were excluded. Using the PRISMA guidelines, 12 studies were selected for further analysis. RESULTS: Primary insufficiency was reportedly the most common etiology of ulcers. Reflux most frequently occurred in the superficial system, either isolated or in conjunction with perforating and/or deep systems. Combined superficial and deep disease was observed in a median of 11.6% of limbs (range of 0-48%). Triple system disease was seen in a median of 31.6% of limbs (range of 22-52%). Isolated deep reflux was infrequently reported (2.1-28.4% of limbs). Previous deep venous thrombosis, reported in a median of 33% of patients, is likely underreported as it may resolve without detectable damage. CONCLUSION: There is a lack of data in the literature regarding the etiology of chronic active venous ulcers. Insufficiency of the superficial venous system from the micro- to the macro-vasculature has been frequently implicated in the development of venous ulceration. A prospective randomized controlled study is required for more conclusive results.
OBJECTIVES: This study was performed to precisely define the underlying pathophysiology in patients with active venous ulcers. METHODS: A PubMed search was conducted from 1991 to 2013 to select papers reporting the anatomic and physiologic etiology of ulceration in CEAP Class 6 patients. Studies which did not decipher between active and healed ulcers, did not use clear definitions, or did not give detailed accounts on the distribution/extent of venous pathology were excluded. Using the PRISMA guidelines, 12 studies were selected for further analysis. RESULTS:Primary insufficiency was reportedly the most common etiology of ulcers. Reflux most frequently occurred in the superficial system, either isolated or in conjunction with perforating and/or deep systems. Combined superficial and deep disease was observed in a median of 11.6% of limbs (range of 0-48%). Triple system disease was seen in a median of 31.6% of limbs (range of 22-52%). Isolated deep reflux was infrequently reported (2.1-28.4% of limbs). Previous deep venous thrombosis, reported in a median of 33% of patients, is likely underreported as it may resolve without detectable damage. CONCLUSION: There is a lack of data in the literature regarding the etiology of chronic active venous ulcers. Insufficiency of the superficial venous system from the micro- to the macro-vasculature has been frequently implicated in the development of venous ulceration. A prospective randomized controlled study is required for more conclusive results.
Authors: Nicholas J Skertich; Justin Gerard; Jennifer Poirier; Martin Hertl; Sam G Pappas; Erik Schadde; Xavier M Keutgen Journal: J Gastrointest Surg Date: 2019-01-22 Impact factor: 3.452
Authors: Craig S Brown; Nicholas H Osborne; Gloria Y Kim; Danielle C Sutzko; Thomas W Wakefield; Andrea T Obi; Peter K Henke Journal: J Vasc Surg Venous Lymphat Disord Date: 2020-06-24
Authors: Arjun S Sebastian; Bradford L Currier; Michelle J Clarke; Dirk Larson; Paul M Huddleston; Ahmad Nassr Journal: Global Spine J Date: 2015-11-26
Authors: Arjun S Sebastian; Bradford L Currier; Sanjeev Kakar; Emily C Nguyen; Amy E Wagie; Elizabeth S Habermann; Ahmad Nassr Journal: Global Spine J Date: 2016-02-17