Flush saphenofemoral ligation and multiple stab phlebectomy preserve a useful greater saphenous vein four years after surgery.

PURPOSE: Flush saphenofemoral ligation, with multiple cosmetic stab phlebectomy, successfully treats saphenofemoral reflux and superficial varicosities. The long-term effect on the residual greater saphenous vein (GSV) requires evaluation. METHODS: Noninvasive triplex ultrasound assessment of the residual GSV for potential use as a vein graft was used. We evaluated the independent objective and subjective cosmetic outcomes. We also used analysis to determine the correlation between GSV reflux, symptoms, and cosmetic outcome. RESULTS: Seventy-two limbs were assessed at a median follow-up of 4 years (interquartile range 3 to 5 years). Fifty-nine limbs had patent GSVs above and below the knee. The mean length patent was 51 cm, and the mean internal diameters above and below the knee were 3.6 and 2.8 mm, respectively. In 65% of cases the vein had suitable ultrasonic characteristics, suggesting that it would be suitable for use as a conduit for a vascular bypass graft. Sixty-two limbs were considered a symptomatic success and 61 an objective cosmetic success. There was no correlation between the symptomatic and cosmetic outcome and the presence of superficial GSV reflux (linear regression analysis). CONCLUSIONS: These findings support the effectiveness of the procedure of flush saphenofemoral ligation and multiple stab phlebectomy with regard to cosmetic and symptomatic outcome and may preserve the GSV for use as an autologous bypass graft.

The aetiology and healing rates of chronic leg ulcers.

Data from published studies of leg ulcer aetiology concentrate on venous and arterial disease as the main aetiological factors. The records of 490 patients attending leg ulcer clinics over a two-year period in 1992 and 1993 were reviewed. Although 58% of the ulcers studied resulted from venous disease, the remainder were caused by a wide range of factors. Our venous ulcer healing rate of 53% at six months was not as impressive as other published data, although this can be accounted for. By comparing the management and outcome for ulcers of various aetiologies, it was shown that they require different methods of treatment, often including referral to another specialty. Ulcers also exhibit differential healing rates depending on the underlying aetiology. Some ulcer aetiologies, particularly vasculitis, present particular problems and have very poor healing rates.

Intravenous digital subtraction angiography versus computed tomography in the assessment of abdominal aortic aneurysm.

Results of preoperative investigation of 127 patients who underwent elective aortic aneurysm repair during a 3-year period were examined and compared with findings at operation. The accuracy of preoperative computed tomography (CT) and intravenous digital subtraction angiography (DSA) in assessing proximal and distal aneurysm extent was compared. From a total of 118 CT scans, ten of 12 suprarenal aneurysms were correctly predicted, with 11 false positives (positive predictive value 48 per cent, sensitivity 83 per cent, specificity 90 per cent). After 103 DSA investigations, six of ten suprarenal aneurysms were correctly predicted with one false positive (positive predictive value 86 per cent, sensitivity 60 per cent, specificity 99 per cent). Using CT, 30 of 54 aneurysmal iliac arteries were correctly diagnosed with 20 false positives (positive predictive value 60 per cent, sensitivity 56 per cent, specificity 88 per cent). Thirty-six of 48 aneurysmal iliac arteries were diagnosed correctly using DSA, with 32 false positives (positive predictive value 53 per cent, sensitivity 75 per cent, specificity 79 per cent). Intravenous DSA also provided useful information about renal and peripheral occlusive disease. Both investigations have their own specific limitations; clinicians should be aware of these when ordering and interpreting them.

A non-vasculitic rheumatoid ulcer.

An account of the care of a patient with rheumatoid arthritis whose recurring leg ulcer was found not to be caused by vasculitis.

From the Journals.

The role of collagenase in wound healing Effect of aspirin on venous ulcer healing Post-discharge wound infection.