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Type: Original Article
Title: Deep vein thrombosis and venous ulcers of lower limbs: the patients’ history and ultrasound findings
Authors: Alberto Garavello, Stefania Gilardi, Paola Fiamma, Massimo Tozzi
Affiliations: Department of Emergency, San Filippo Neri Hospital, Rome 00135, Itlay.
Abstract: Aim: Ulcers of lower limbs affect 1% of Western population. In most cases, ultrasound shows only insufficiency of superficial veins (SV), but in many patients there is also insufficiency of the deep veins (DV). It may be postphlebitic, but sometimes there is not a clear history of Deep Vein Thrombosis (DVT). In this paper, we focused on these patients to highlight possible causes of DV insufficiency leading to ulcers, in absence of a previous DVT.
Methods: 124 lower limbs of patients with varicose ulcer (50 males - 74 females, at the age of 29 to 91, with the average of 70.6), were examined in our institution, with reference to DVT history; 57 patients were DVT positive (DVT +), and 67 DVT negative (DVT-). All patients underwent an history-taking and physical examination, and then an echocolordoppler study was carried out.
Results: Insufficiency of SV was substantially overlapping between two groups, insufficiency of DV was greater in DVT +; however, in left limbs of DVT- patients, there was an unexpected insufficiency of popliteal vein in 8 patients. It is possible that the patient cases suffered a silent TVP after a stripping operation (in 5 of 8 patients), while in others it may be a primary insufficiency.
Discussion: Status of DV in ulcer patients is crucial for both surgical therapy and prognosis; primitive DV insufficiency or an unrecognized DVT must always be kept in mind also in TVP- patients.
Keywords: Ulcer, deep vein thrombosis, varicose veins