Eighty-five limbs in 73 patients with a healed venous ulcer were assessed by ascending and descending phlebography, foot volume plethysmography and transcutaneous oxygen measurements. Forty-four limbs had post-thrombotic changes on ascending phlebography. In 24 (28 per cent) these extended into the femoral vein, while in 20 (24 per cent) only the calf veins were involved. In the 41 limbs (48 per cent) with normal deep veins on ascending phlebography, 11 had evidence of localized incompetence of the calf communicating veins, 14 had either long saphenous incompetence, deep vein reflux to the level of the knee or below, or both of these abnormalities, and 16 limbs had no phlebographic abnormalities. However all limbs had a decreased half volume refilling time on foot volume plethysmography. Limbs with post-thrombotic changes extending into the femoral vein were associated with a significantly longer history of ulceration and more ulcer recurrences than limbs with calf vein damage (P less than 0.05 for each) and limbs with normal deep veins (P less than 0.01 for each). However, these limbs did not have lower transcutaneous oxygen ratios or longer times to achieve ulcer healing. Ascending phlebography identified a group of limbs with extensive post-thrombotic changes in which there was a higher incidence of ulcer breakdown, but this was not associated with a delay in ulcer healing.

译文

通过上升和下降静脉造影,足体积体积描记术和经皮氧气测量,评估了73例静脉溃疡愈合患者的85个肢体。上升静脉造影时,四十四个肢体有血栓后变化。在24 (28%) 中,这些延伸到股静脉,而在20 (24%) 中,仅涉及小腿静脉。在上升静脉造影的41条正常深静脉的肢体 (48%) 中,有11条有小腿连通静脉局部无能的证据,14条有长隐无能,深静脉反流至膝盖或以下水平,或这两种异常,16条肢体无静脉造影异常。然而,在脚部体积描记术上,所有肢体的填充时间都减少了一半。血栓后改变延伸到股静脉的肢体与小腿静脉损伤的肢体 (每条P小于0.05) 和正常深静脉的肢体 (每条P小于0.01) 相比,溃疡病史明显更长,溃疡复发更多。但是,这些肢体没有较低的经皮氧气比率或更长的时间来实现溃疡愈合。上升静脉造影发现了一组具有广泛血栓后变化的肢体,其中溃疡破裂的发生率更高,但这与溃疡愈合的延迟无关。

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