Influence of gene polymorphisms in ulcer healing process after superficial venous surgery Donato Gemmati, MS, Silvia Tognazzo, MS, Linda Catozzi, MS,

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Influence of gene polymorphisms in ulcer healing process after superficial venous surgery Donato Gemmati, MS, Silvia Tognazzo, MS, Linda Catozzi, MS, Federica Federici, MS, Massimiliano De Palma, MD, Sergio Gianesini, MD, Gian L. Scapoli, MD, Monica De Mattei, MS, Alberto Liboni, MD, Paolo Zamboni, MD Journal of Vascular Surgery Volume 44, Issue 3, Pages 554-562 (September 2006) DOI: 10.1016/j.jvs.2006.05.011 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, Hemodynamic correction procedure performed for type I presentation. Left panel: reflux from the saphenofemoral junction (SFJ) flows downward along the main saphenous trunk (GSV) to the varicose tributary (T) and to the re-entry perforating vein (RPV). Right panel: operation consisted in flush legation and disconnection of the GSV from the femoral vein, and of the T from the GSV. We eliminated in this way the reflux point with change of compartments from deep to saphenous compartment, and from saphenous compartment to the superficial one, respectively. In the GSV, we so obtained a reverse flow from the junction to the RPV, and a forward flow from the foot to the RPV. Air-plethysmography parameters assessed the effectiveness of the procedure.20 B. Hemodynamic correction procedure performed for type II presentation. Left panel: reflux from the SFJ flows downward along the GSV to the T without re-entry perforating vein detectable along the GSV. Right panel: operation consisted in flush legation and disconnection of the T from the GSV. In the GSV, we also obtained a forward flow. Air-plethysmography parameters assessed the effectiveness of the procedure.21 Journal of Vascular Surgery 2006 44, 554-562DOI: (10.1016/j.jvs.2006.05.011) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Healing time and FXIII-V34L polymorphism distribution in the whole cohort of patients with chronic venous ulcer investigated in the study. L34 carriers indicate cases with FXIII-VL34 or FXIII-LL34 genotype. The line indicates a median healing time of eight weeks. The P value indicates the statistical significance between the percentage of FXIII-L34 carriers in cases with healing time above and below the median. Journal of Vascular Surgery 2006 44, 554-562DOI: (10.1016/j.jvs.2006.05.011) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Kaplan-Meier analysis for chronic venous ulcer patients stratified by FXIII-V34L genotypes (log-rank test, P =.00001). Journal of Vascular Surgery 2006 44, 554-562DOI: (10.1016/j.jvs.2006.05.011) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Relationships between mean healing time and different FXIII genotypes. The whole cohort of patients with chronic venous ulcers is shown and the subgroups carrying the FXIII-V34L and FXIII-P564L genotypes. L34 carriers indicate patients with FXIII-VL34 or FXIII-LL34 genotype, and L564 carriers indicate patients with the FXIII-PL564 or FXIII-LL564 genotype. The lines and values shown indicate the different mean healing times and standard deviation. P values indicate the statistical significance between mean healing times for each specific FXIII genotype. Journal of Vascular Surgery 2006 44, 554-562DOI: (10.1016/j.jvs.2006.05.011) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Healing time distribution in two subgroups of patients with chronic venous ulcers carrying the FXIII-VV34/PP564 double wild type (WT) genotype, and the FXIII-VL/LL34+PL/LL564 genotype (double carriers), respectively. The line and value shown indicate the different mean healing times and standard deviation. The P value indicates the statistical significance between the two mean healing times. Journal of Vascular Surgery 2006 44, 554-562DOI: (10.1016/j.jvs.2006.05.011) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions