RESUMEN
Background: Recurrence or persistence of a chronic venous insufficiency ulcer could be multifactorial. Incompetent perforators, presence of associated arterial insufficiency, are possible causes that are easily identified during color duplex limb check A section of those recurrent ulcers did not have an apparent explanation until attention was drawn to a hidden factor which is vasculitis
Aim of the work: To identify vasculities as a cause of persistent or recurrent venous ulcer in the lower extremity, and to observe response to vasculities treatment, upon healing of the venous ulcer
Patients: Seventeen patients with non-healing venous ulcer [CEAP 6] were studied, where neither arterial insujfzciency nor any more leaking perforators were present
Methods: Repeat color duplex examination for arterial and venous system was performed, search for any associated disease that may alter the immune system e.g. malignancy... etc., and lab test for possibility of collagen disorder including; ESR, CRP Quantitative, ANA. Anti Ds DNA, Rheumatoid factor, Rose Waller, Anti Ro [SSA], Lupus anticoagulant, ANCA, Viral markers: HCV antibody and H85 antigen. Immunosuppressive therapy was started in the form of combination of Prednisolone, Methotrexate, and Azathioprin, and observation of the ulcer healing
Results: Repeat color duplex for new perforator incompetence was positive in 16 [94.1%] of the 17 persistent venous ulcer. Among those 16 patients repeated petforator ligation with development of other new perforator necessitated surgery repetition. Each time, there was partial ulcer improvement followed by deterioration. At the end, all of the cases had no new perforators at the time of study enrollment. Colour duplex of arterial system Showed patent lower limb arterial system in all cases. Overall incidence ofpersistence venous ulcer in the study Was 17/630 cases [2.69%]. Malignancy detected in two of the study cases; follicular cancer thyroid and 'hyelaproliferative disorder. ESR and CRP quantitative were raised in all cases, some patients had more than one positive result. Response to immunosuppressive therapy, prednisolone + methotroxate + Azathioprin] an ulcer healing was complete in 5 [29.4%], and partial in 12 [70.6%] cases
Conclusion: Leg ulcers in chronic venous insuj72ciency patients associated with vasculitis are due to triggered factors which activate the immunopathological mechanisms. They are typically chronic, slow to heal, and commonly recur.