Autotransplant as Salvage for Patients With Posterior Nutcracker and Failed Left Renal Vein Transposition

enrolled in these RCTs to a population of patients with venous ulcers (C6) in a community-based wound clinic in the Midwest of the United States.Methods: Information on C6 patients with correctable GSV reflux treated in a wound clinic was prospectively collected during 2-year period with at least 1-year follow up.Patients with recurrent ulcers (C6r) were not included.Study patients were stratified into two groups: those who received only compression therapy and those who had GSV ablation within the first month from initial visit, followed by compression therapy.Demographics, and outcomes were compared between the two groups and with the published data from the RCTs.Results: A total of 118 patients were included in the study.Compared with RCTs, there were more patients with diabetes (44% vs 7.5% and 13.8%).Although such information is not available for either one of the RCTs, there was a high prevalence of congestive heart failure (53.4%) and morbid obesity (43.2%) in the study population (Table ).The outcomes in patients with BMI <40 were similar to those in the RCTs (ie, the medium time to ulcer healing was 60 days in ablation group and 79 days in compression group; the corresponding 12-months recurrence rates were 14% and 25%).However, in the morbid obesity group, the medium time to ulcer healing was 80 days in the ablation group and 71 days in the compression group, with the same recurrence rate of 23%.Conclusions: The results of this study indicate that real-world population of patients with venous ulcers is different from included in RCTs.Morbidly obese patients demonstrated different outcome patterns from those shown by the RCTs.This group of patients needs to be studied to define the best treatment option.