Aktif ya da İyileşmiş Venöz Ülser Tedavisinde Doppler Ultrason ile İşaretlenmiş Perforan Venlerin Subfasiyal Açık Ligasyonunun Yeri; Orta-Geç Dönem Sonuçlarımız

Objective: Intervention of the superficial veins with the perforating veins are known to be useful in the treatment of active or healed ulcers" healing and relapse prevention. Percutaneous laser ablation and subfascial endoscopic perforator surgery (SEPS) do not have widespread use in our country because of the cost effectivity and maybe due to the lack of experience. Many of the cardiovascular centers do not prefer to perform foam sclerotherapy. On the other hand, the disaduantages of the convantional techniques are the wound problems and prolonged hospitalization. We concluded that doppler-ultrasound guided conventional techniques could be performed until the use of less invasive techniques and satisfactory long-term results are common. Material and Methods: Forty five patients with active or healed venous ulcers who were operated between 2005 and 2012 were included in this study. The techniques of surgery which performed to these patients were surgical stripping or laser ablation of greater saphenous vein with phlebectomy and subfascial ligation of perforating veins. To perform the ligation, we marked the perforators by using Doppler-ultrasound, then insiced the the skin vertically on this marked surface. The patients were followed up at the first, second and fourth weeks after the surgery. Outpatient follow up was done for six months. Results: There was no mortality in the study group. In this study, we performed 83 perforating vein ligations. Mean follow up period was 46±4 months. In this period, we observed deep venous trombosis which was limited with crural veins postoperatively once (2.2%). The recurrence of ulcer was seen in one of the patients (2.2%) at the 48 months of follow up. Surgical wound problems appeared in two patients (4.4%). The patients who had healed ulcers and 27 of 28 patients who had active ulcers, were treated successfully and no recurrence was observed. The average time of healing of the ulcers was 6 weeks. Conclusion: The surgical approach that we performed to the superficial and perforating systems together at the same time is beneficial and has low complication rates in the treatment of the active or healed leg ulcers. We conclude that open surgical ligation of perforating veins with guidance of Doppler-ultrasound is a reliable approach of the treatment, until the minimally invasive interventions such as SEPS and especially laser ablation of perforating veins become more successful and accessible.