Surgical Management

There is growing evidence that saphenous surgery improves the quality of life in patients with VVs, and augments the healing and reduces the recurrence of CVU better than compression alone (Dwerryhouse et al., 1999). For optimal results, it is necessary to define the extent and severity of venous disease, usually by means of DU, prior to surgery. Surgery for CVU

is different from that for uncomplicated VVs in a number of important ways. The patients are older and often have multisystem, medical comorbidity; the risks, especially DVT, are higher. Patients may require inpatient optimization of cardiorespiratory function, treatment of dermatitis, edema reduction, and desloughing of the ulcer. The effect of deep venous reflux on the efficacy of superficial venous surgery is controversial and incompletely defined. Deep reflux due to PVI may reverse once superficial reflux has been eradicated. However, most agree that patients with extensive PTS gain less benefit from surgery. Secondary VVs that are acting as collaterals must not be removed. Although postoperative compression therapy has been shown to reduce VVs and CVU recurrence, compliance is poor.

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