Treatment
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Deep Venous Reflux With Skin Changes at Risk for Venous Leg
Ulcer (C4b), Healed (C5) or Active (C6) Venous Leg Ulcer–
Ligation
➤ In a patient with infrainguinal deep venous reflux and skin changes at
risk for venous leg ulcer (C4b), healed venous leg ulcer (C5), or active
venous leg ulcer (C6), we suggest against deep vein ligation of the
femoral or popliteal veins as a routine treatment. (2-C)
Deep Venous Reflux With Skin Changes at Risk for Venous Leg
Ulcer (C4b), Healed (C5) or Active (C6) Venous Leg Ulcer–
Primary Valve Repair
➤ In a patient with infrainguinal deep venous reflux and skin changes at
risk for venous leg ulcer (C4b), healed venous leg ulcer (C5), or active
venous leg ulcer (C6), we suggest individual valve repair for those
who have axial reflux with structurally preserved deep venous valves
in addition to standard compression therapy to aid in venous ulcer
healing and to prevent recurrence. (2-C)
Deep Venous Reflux With Skin Changes at Risk for Venous Leg
Ulcer (C4b), Healed (C5) or Active (C6) Venous Leg Ulcer–Valve
Transposition or Transplantation
➤ In a patient with infrainguinal deep venous reflux and skin changes
at risk for venous leg ulcer (C4b), healed venous leg ulcer (C5),
or active venous leg ulcer (C6), we suggest valve transposition or
transplantation for those with absence of structurally preserved
axial deep venous valves when competent outflow venous pathways
are anatomically appropriate for surgical anastomosis in addition to
standard compression therapy to aid in venous leg ulcer healing and
to prevent recurrence. (2-C)
Deep Venous Reflux With Skin Changes at Risk for Venous Leg
Ulcer (C4b), Healed (C5) or Active (C6) Venous Leg Ulcer–
Autogenous Valve Substitute
➤ In a patient with infrainguinal deep venous reflux and skin changes at
risk for venous leg ulcer (C4b), healed venous leg ulcer (C5), or active
venous leg ulcer (C6), we suggest consideration of autogenous valve
substitutes by surgeons experienced in these techniques to facilitate
ulcer healing and to prevent recurrence in those with no other option
available in addition to standard compression therapy to aid in venous
ulcer healing and to prevent recurrence. (2-C)
