Surgical Treatment for Lower Leg Stasis Ulceration Caused by Chronic Venous Disease

Abstract

Stasis ulcers of the lower leg are sometimes left untreated or are maltreated for long periods. Although there are some reports showing the effectiveness of conservative treatment, we believe surgical intervention is superior in terms of quickness and radicality of ulcer healing. Our strategy for a stasis leg ulcer is; 1. for a severe deep valve insufficiency we apply deep venous external valvuloplasty using a rigid angioscope. 2. For massive arterio-venous communication, coil embolization to the feeding arteries is performed followed by superficial venous treatment. 3. For other venous diseases we perform high saphenous ligation or stripping. Since 2002, we have treated 29 patients (31 legs) for stasis ulcers. We undertook valvuloplasty in 5 patients (7 legs), coil embolization with stripping in 2, stripping only in 11, and high ligation with perforating vein ligation in 11. There were no operation-related deaths and no major complications. During the mean follow up of 1.5 years, the ulcers healed in 26 patients, improved in one and recurred in two. One recurrence occurred after re-do ligation of the vein, but a duplex scan revealed no venous disorders though the ulcer remained. We concluded that our surgical strategy for stasis leg ulceration was an acceptable treatment method. However, some ulcers remain unhealed, implying the presence of other unknown factors related to the ulcer.