Correlation between Leg Ulceration and Perforator Venous Insufficiency (PVI) in Patients (Pts) with Sickle Cell Disease (SSD).

Chronic or recurrent leg ulceration occurs in 25% of adult SSD pts, but as many as 75% never develop leg ulcers. PVI correlates with leg ulceration in non-SSD pts. We studied 46 SSD pts: 40 with hemoglobin (Hb) SS, 3 with sickle-b thalassemia, 2 with Hb SC and 1 with Hb SD. Chronic and/or recurrent leg ulceration was present on at least 1 leg of 25/46 (ulcer+) and absent in 21/46 (ulcer-) SSD pts. Their ages ranged from 19–67 years, with a median of 31. Using color-flow venous duplex (7–5 mega-Herz probe; Advanced Technology Laboratory 5000), the status of perforator veins in both legs of each pt was determined (only one of a single pt’s two ulcerated legs was studied). Perforator veins were considered incompetent (PVI) if their diameter was >3 mm, and their reflux times were >0.35 seconds. For the 36/91 ulcer+ and 55/91 ulcer- legs, there was a significant association between PVI and ulceration in the same leg (generalized mixed linear model, p=0.002). Estimated probability of ulceration in a non-PVI leg was 0.20 (95% confidence interval [0.10, 0.36]); estimated probability of ulceration in a PVI leg was 0.61 (95% CI [0.41, 0.79]). Odds ratio was 6.2 (95% CI [2.0, 19]). The prevalence of ulceration in either leg, among 22 pts with PVI in at least 1 leg, was compared with that among 23 pts with PVI in neither leg (omitting the pt with one unstudied leg). There was significant association between ulceration in either leg and PVI in either leg (Fisher’s exact test p<0.001). Estimated probability of ulceration in either leg when neither leg had PVI was 0.22 (95% confidence interval [0.07, 0.44]); estimated probability of ulceration in either leg when either leg had PVI was 0.86 (95% CI [0.65, 0.97]). Odds ratio was 23 (95% CI [4.7, 110]). PVI may be involved in the pathogenesis of leg ulceration in pts with SSD.