Presentation Of Patients With

A commonly held perception is that less severe CVI (CEAP clinical classes 2-3) is typically a sequela of superficial venous reflux, whereas more severe CVI (CEAP classes 4-6) is associated with deep venous reflux. For this reason, the majority of patients treated with venous leg ulcers are never referred to a venous specialist for consideration of a corrective procedure. It is mistakenly believed that all are due to deep venous disease and that none are candidates for correction of reflux or obstruction. Several authors have defined the anatomy of reflux in patients with advanced CVI, and isolated saphenous or saphenous and perforator reflux is not uncommon, occurring in 20 to 35% of patients in various series. Also, as outlined by Drs. Neglen, Raju, and Kistner in other chapters, many patients with deep venous insufficiency causing severe CVI may be improved with surgical or endovenous procedures, reducing symptoms and the incidence of recurrent ulcers.

For these reasons, all patients with advanced CVI with or without limb ulceration who are candidates for corrective procedures should be studied with diagnostic studies to determine the anatomy and physiology of their individual case. Referral to a venous specialist familiar with surgical and nonsurgical options will allow the optimal method of correction to be selected.

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