Abstract：
BACKGROUND: The optimal treatment approach for patients with active venous leg ulcers (VLUs) and post-thrombotic syndrome (PTS) associated with great saphenous vein (GSV) reflux remains unclear. To address this gap, we retrospectively compared the outcomes of patients with post-thrombotic VLU with an intact GSV vs those with a stripped or ablated GSV.
METHODS: We retrospectively analyzed data from 48 patients with active VLUs and documented PTS, who were treated at a single center between January 2018 and December 2022. Clinical information, including ulcer photographs, was recorded in a prospectively maintained digital database at the initial and follow-up visits. Two patient groups-group A (with an intact GSV) and group B (with a stripped or ablated GSV)-were compared in terms of time to complete healing, proportion of ulcers achieving complete healing, and ulcer recurrence during the follow-up period.
RESULTS: There were no significant differences in age, gender, initial ulcer size, or ulcer duration between the two groups. All included patients had femoropopliteal post-thrombotic changes. Group A had significantly more completely healed ulcers (33 of 34 ulcers, 97%) compared with group B (10 of 14 ulcers, 71%) (P = .008). Group A also exhibited a significantly shorter time to complete ulcer healing (median: 42.5 days, interquartile range [IQR]: 65) compared with group B (median: 161 days, IQR: 530.5) (P = .0177), with a greater probability of ulcer healing (P = .0084). Long-term follow-up data were available for 45 of 48 patients (93.7%), with a mean duration of 39.6 months (range: 5.7-67.4 months). The proportion of ulcers that failed to heal or recurred during the follow-up period was significantly lower in group A (9 of 32 ulcers, 27%) compared with group B (11 of 13 ulcers, 85%) (P = .0009). In addition, in a subgroup analysis, patients with an intact but refluxing GSV (12 of 34) had a significantly shorter time to heal (median: 34 days, IQR: 57.25) (P = .0242), with a greater probability of ulcer healing (P = .0091) and significantly fewer recurrences (2 of 12, 16%) (P = .006) compared with group B.
CONCLUSIONS: Our findings suggest that removal of the GSV through stripping or ablation in patients with post-thrombotic deep venous systems affecting the femoropopliteal segment may result in delayed ulcer healing and increased ulcer recurrence. Patients with an intact GSV had better outcomes, even when the refluxing GSV was left untreated. These findings emphasize the potential impact of GSV treatment on the management of VLUs in individuals with PTS. Further investigation is needed to validate these results and explore alternative therapeutic strategies to optimize outcomes for this patient population.
METHODS: We retrospectively analyzed data from 48 patients with active VLUs and documented PTS, who were treated at a single center between January 2018 and December 2022. Clinical information, including ulcer photographs, was recorded in a prospectively maintained digital database at the initial and follow-up visits. Two patient groups-group A (with an intact GSV) and group B (with a stripped or ablated GSV)-were compared in terms of time to complete healing, proportion of ulcers achieving complete healing, and ulcer recurrence during the follow-up period.
RESULTS: There were no significant differences in age, gender, initial ulcer size, or ulcer duration between the two groups. All included patients had femoropopliteal post-thrombotic changes. Group A had significantly more completely healed ulcers (33 of 34 ulcers, 97%) compared with group B (10 of 14 ulcers, 71%) (P = .008). Group A also exhibited a significantly shorter time to complete ulcer healing (median: 42.5 days, interquartile range [IQR]: 65) compared with group B (median: 161 days, IQR: 530.5) (P = .0177), with a greater probability of ulcer healing (P = .0084). Long-term follow-up data were available for 45 of 48 patients (93.7%), with a mean duration of 39.6 months (range: 5.7-67.4 months). The proportion of ulcers that failed to heal or recurred during the follow-up period was significantly lower in group A (9 of 32 ulcers, 27%) compared with group B (11 of 13 ulcers, 85%) (P = .0009). In addition, in a subgroup analysis, patients with an intact but refluxing GSV (12 of 34) had a significantly shorter time to heal (median: 34 days, IQR: 57.25) (P = .0242), with a greater probability of ulcer healing (P = .0091) and significantly fewer recurrences (2 of 12, 16%) (P = .006) compared with group B.
CONCLUSIONS: Our findings suggest that removal of the GSV through stripping or ablation in patients with post-thrombotic deep venous systems affecting the femoropopliteal segment may result in delayed ulcer healing and increased ulcer recurrence. Patients with an intact GSV had better outcomes, even when the refluxing GSV was left untreated. These findings emphasize the potential impact of GSV treatment on the management of VLUs in individuals with PTS. Further investigation is needed to validate these results and explore alternative therapeutic strategies to optimize outcomes for this patient population.
摘要：
背景：对于活动性下肢静脉性溃疡（VLU）和与大隐静脉（GSV）反流相关的血栓后综合征（PTS）患者的最佳治疗方法仍不清楚。为了解决这个差距，我们回顾性比较了完整GSV与剥离或消融GSV的血栓形成后下肢静脉溃疡患者的结局.
方法：我们回顾性分析了48例活动性VLU患者的数据，并记录了PTS，2018年1月至2022年12月在单中心接受治疗。临床信息,包括溃疡照片,在初次访问和后续访问时记录在前瞻性维护的数字数据库中。两组患者-A组（完整的GSV）和B组（剥离或消融的GSV）-在完成愈合的时间方面进行了比较，达到完全愈合的溃疡比例，随访期间溃疡复发。
结果：年龄没有显著差异，性别,初始溃疡大小，或溃疡持续时间在两组之间。所有纳入的患者都有股动脉血栓后改变。A组有明显更完全愈合的溃疡：34个溃疡中有33个（97％），与B组14个溃疡中的10个(71%)相比(p=0.008)。A组溃疡愈合时间明显缩短(中位数为42.5天,IQR65)与B组(中位数161天，IQR530.5)(p=0.0177)，溃疡愈合的可能性更大（p=0.0084）。48例患者中有45例（93.7%）获得了长期随访数据，平均持续时间为39.6个月（范围：5.7-67.4个月）。A组随访期间未愈合或复发的溃疡比例明显较低(32个溃疡中有9个,27%)与B组(13个溃疡中有11个，85%)(p=0.0009)。此外,在亚组分析中，GSV完整但返流的患者（34人中有12人）的愈合时间明显较短（中位数为34天，IQR57.25)(p=0.0242)，与B组相比,溃疡愈合的可能性更大(p=0.0091),复发明显更少(12个中的2个,16%)(p=0.006)。
结论:我们的研究结果表明,在血栓后深静脉系统患者中,通过剥除或消融术去除GSV可能导致溃疡愈合延迟和溃疡复发增加。GSV完整的患者有更好的结果，即使回流的GSV未处理。这些发现强调了GSV治疗对PTS患者静脉腿部溃疡管理的潜在影响。需要进一步的研究来验证这些结果并探索替代治疗策略以优化该患者群体的结果。
方法：我们回顾性分析了48例活动性VLU患者的数据，并记录了PTS，2018年1月至2022年12月在单中心接受治疗。临床信息,包括溃疡照片,在初次访问和后续访问时记录在前瞻性维护的数字数据库中。两组患者-A组（完整的GSV）和B组（剥离或消融的GSV）-在完成愈合的时间方面进行了比较，达到完全愈合的溃疡比例，随访期间溃疡复发。
结果：年龄没有显著差异，性别,初始溃疡大小，或溃疡持续时间在两组之间。所有纳入的患者都有股动脉血栓后改变。A组有明显更完全愈合的溃疡：34个溃疡中有33个（97％），与B组14个溃疡中的10个(71%)相比(p=0.008)。A组溃疡愈合时间明显缩短(中位数为42.5天,IQR65)与B组(中位数161天，IQR530.5)(p=0.0177)，溃疡愈合的可能性更大（p=0.0084）。48例患者中有45例（93.7%）获得了长期随访数据，平均持续时间为39.6个月（范围：5.7-67.4个月）。A组随访期间未愈合或复发的溃疡比例明显较低(32个溃疡中有9个,27%)与B组(13个溃疡中有11个，85%)(p=0.0009)。此外,在亚组分析中，GSV完整但返流的患者（34人中有12人）的愈合时间明显较短（中位数为34天，IQR57.25)(p=0.0242)，与B组相比,溃疡愈合的可能性更大(p=0.0091),复发明显更少(12个中的2个,16%)(p=0.006)。
结论:我们的研究结果表明,在血栓后深静脉系统患者中,通过剥除或消融术去除GSV可能导致溃疡愈合延迟和溃疡复发增加。GSV完整的患者有更好的结果，即使回流的GSV未处理。这些发现强调了GSV治疗对PTS患者静脉腿部溃疡管理的潜在影响。需要进一步的研究来验证这些结果并探索替代治疗策略以优化该患者群体的结果。
