| Background:Venous leg ulcers are common clinical vascular disease of lower extremity.Its incidence rate is positively correlated with the increase of age.Venous diseases account for 60%of vascular surgical diseases.VLUs account for about 80%of chronic ulcer of the lower limbs,which seriously affect the quality of patients’ life and social economy.VLUs patients are classified as C5 and C6 in CEAP,and they are often scored by venous clinical severity score.Serious complications of VLUs include infection and malignant transformation.The long-term increase of lower extremity venous system pressure and the change of local skin microenvironment are important factors for the formation of VLUs.Although many studies have revealed the injury,inflammation and repair mechanism of VLUs,the specific pathogenesis has not been fully explained.Old age,obesity,lower extremity deep venous thrombosis and multiple pregnancy history are all risk factors for the formation of VLUs.The treatment of VLUs mainly includes non-surgical treatment and surgical treatment.The ultimate goal is to improve the quality of patients’ life and reduce the recurrence rate of VLUs.Objective:To analyze the relationship between VLUs and pathological perforating vein in position,quantity and diameter.To analyze the curative effect and recurrence rate of different treatment methods.Methods:The clinical data of 151 patients with VLUs treated in the Department of vascular surgery of the Affiliated Hospital of Yangzhou University from January 2019 to June 2021 were analyzed retrospectively.There were 103 males and 48 females,aged from 21 to 94 years,with an average age of（65.5±11.6）years.All patients underwent color Doppler ultrasonography of lower limb vessels to eliminate lower limb thrombosis.Anterograde Venography of lower limbs was performed after iohexol contrast agent skin test.After admission,all patients raised affected limb and received adjuvant treatment such as drug treatment and pressure treatment.42 patients were treated conservatively during hospitalization,and 109 patients were treated surgically.Among them,91 patients were treated with modified high ligation and stripping of great saphenous vein and point stripping of superficial varicose vein combined with SEPS,The remaining 18 cases were treated with modified high ligation and stripping of great saphenous vein and point stripping of varicose superficial vein.After treatment,all patients were ordered to follow up 2 weeks and 1 month after discharge,recheck the color Doppler ultrasound of lower limb vessels,understand the ulcer healing and evaluate the VCSS score of patients.Results:Of the 151 patients included in this study,95 were located in the simple left lower limb.The lesions were located in the right lower limb in 54 cases.The lesions were located in both lower limbs in 2 cases,including 1 male and 1 female.The results of Anterograde Venography of lower limbs showed that the ulcer occurred in the medial leg and above the medial malleolus.It was found that the ulcer had a developing perforating vein,which was directly related to it.The ulcer area was positively correlated with the diameter of the developing pathological perforating vein（r=0.818,P<0.05）,and the ulcer area was positively correlated with the number of developing pathological perforating veins（r=0.860,P<0.05）.The treatment plan was determined according to the basic clinical data and auxiliary examination results,and 42 patients chose conservative treatment,18 patients were treated with modified high ligation and stripping of great saphenous vein and dot stripping of superficial varicose vein.The other 91 patients were treated with modified high ligation and stripping of great saphenous vein and point stripping of superficial varicose vein combined with SEPS.There was no significant difference in VCSS score between conservative treatment group and operation group（P=0.747）.After two follow-up visits after discharge,it was found that the VCSS score of all patients was lower than that at admission,and the difference was statistically significant（P<0.05）.There was no significant difference in VCSS score between traditional operation group and combined SEPS operation group（P=0.112）.The VCSS score of 1 month after discharge was significantly lower in the combined SEPS operation group（P<0.05）.There was no significant difference in the recurrence rate between the traditional operation group and the combined SEPS operation group（P=0.421）.Conclusion:According to the results of Anterograde Venography of lower limbs,the following conclusions are summarized:（1）there are 1～3 pathological perforating veins in the ulcer on the medial leg and above the medial malleolus,which are directly related to the ulcer,and the number and diameter of pathological perforating veins are positively related to the ulcer area;（2）In the lateral ankle joint and the lateral posterior side of the lower leg,there are different correlations due to the different location and area of the ulcer.When the ulcer is located at the proximal end of the lower leg（i.e.far away from the lateral ankle）,the non developing perforating vein is directly related to the ulcer;（3）No directly related venipuncture was found in the anterior tibial ulcer.According to different treatment results,the following conclusions are drawn:（1）surgical treatment can significantly improve the speed of ulcer healing and improve the postoperative VCSs score of patients,and the medium and long-term improvement of combined SEPs surgical treatment is more obvious;（2）Surgical treatment can significantly reduce the long-term recurrence rate of patients,and the recurrence rate after SEPs is low,but there is no significant difference in the recurrence rate between the two surgical methods in this study（considering that the number of cases included in this study is small and the follow-up time is short）. |
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