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Int J Angiol 2022; 31(02): 113-119
DOI: 10.1055/s-0042-1743408
Original Article

Deep Venous Thrombosis and Ulcers of Lower Limbs: Ultrasound Findings in 156 Patients

Alberto Garavello
1   UOC Chirurgia d'Urgenza e del trauma fondazione Policlinico Universitario A.Gemelli IRCCS – Roma
,
Stefania Gilardi
2   Centro Per la Terapia Dell'ulcera Venosa e Arteriosa, Ospedale San Filippo Neri -ASL RM1, Roma, Italy
,
Paola Fiamma
2   Centro Per la Terapia Dell'ulcera Venosa e Arteriosa, Ospedale San Filippo Neri -ASL RM1, Roma, Italy
,
Valentina Toti
2   Centro Per la Terapia Dell'ulcera Venosa e Arteriosa, Ospedale San Filippo Neri -ASL RM1, Roma, Italy
,
Massimo Tozzi
3   Ricercatore in Scienze Statistiche, Roma, Italy
,
Pietro Fransvea
4   Dipartimento di Chirurgia D'urgenza, Policlinico Agostino Gemelli, Roma, Italy
› Author Affiliations Funding None declared.
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Abstract

Venous ulcers (VUs) of lower limbs affect 1% of Western population. In most cases, ultrasounds show only superficial venous insufficiency (SVI), but a deep venous insufficiency (DVI) may also be present without a history of deep vein thrombosis (DVT). To assess SVI and DVI in DVT-positive and DVT-negative patients with VU, a retrospective cohort of 123 patients entered the study (50 male and 73 female, minimum age 29 years and maximum age 90 years, and mean 70.6 years). In 56 patients (45.5%), ulcer was on the right leg, in 52 (42.3%) on the left leg, and in 15 patients (12.2%), ulcer was bilateral, resulting in a total number of 138 limbs in the study. Sixty-six patients suffered DVT, while in 72 anamnesis was negative. Color duplex ultrasound was performed on both limbs, which revealed insufficiencies of superficial and/or deep veins in 18 limbs which had not been affected by an ulcer or a previous DVT. So the study was on 156 limbs. SVI were substantially overlapping in two groups (p-value = 0.593), while combined SVI and DVI was 72.5% in DVT positive limbs (p-value = 0.001). In 70% of cases with a femoral vein insufficiency (p-value = 0.036) or popliteal vein insufficiency (PVI) (p-value 0,003), a DVT history was present. Of 18 limbs, although not affected by ulcer or previous DVT, eight were positive for DVI (two femoral veins and six popliteal veins). In the patient with VU, the history of DVT is a strong predictor of DVI insufficiency. In DVT-positive patients with ulcer, the number of “combined superficial and deep insufficiencies” appears to be particularly significant and surgical treatment must take this into account. A previous DVT has a low impact on great and small saphenous insufficiencies in ulcer patients; these were substantially overlapping in DVT-positive and DVT-negative patients. The 18 limbs with DVI and SVI without ulcer and DVT history were unexpected result. We think these patients must have a close follow-up to avoid the onset of a VU.

Keywords

ulcer - deep venous thrombosis - great saphenous vein insufficiency - small saphenous vein insufficiency - popliteal vein


Publication History

Article published online:
10 March 2022

© 2022. International College of Angiology. This article is published by Thieme.

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