Long saphenous incompetence as a cause of venous ulceration.

Four hundred and seventeen consecutive patients referred with significant chronic venous disorders of the lower limb have been studied. Two hundred and ninety-nine were considered to have uncomplicated primary varicose veins, with saphenous incompetence. The remaining 118 presented with past or current skin ulceration, prominent pain and swelling, or both. Ascending and descending venography and further Doppler studies revealed only 18 patients (17 with ulceration) with an incompetent long saphenous system and ankle perforators as the only identifiable abnormalities. In 12 of these, patients' dorsal foot vein pressures were measured at rest and the maximum fall demonstrable after exercise expressed as a percentage of this (12.9 per cent +/- 6.0). This test was repeated with a narrow tourniquet inflated to 160 mmHg, applied to the mid-thigh (35.6 per cent +/- 7.4) (P less than 0.05), and again after accurate groin ligation and stripping of the long saphenous vein to the knee (31.9 per cent +/- 10.7) (P less than 0.05). These results seem to validate the use of the foot pressure/tourniquet test in assessing the relevance of saphenofemoral incompetence, and suggest in a proportion of venous ulcers this is a princical factor.