scholarly journals Comparison of combined compression and surgery with high ligation-endovenous laser ablation-foam sclerotherapy with compression alone for active venous leg ulcers

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiaochun Liu ◽  
Guofu Zheng ◽  
Bo Ye ◽  
Weiqing Chen ◽  
Hailiang Xie ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Ulcer Healing ◽  
Healing Time ◽  
High Ligation ◽  
Ulcer Recurrence ◽  
Leg Ulcers ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Recurrence Rates ◽  
Endovenous Laser Ablation

Abstract We aimed to assess the ulcer healing time and recurrence rates after treatment with compression therapy (CT) with or without high ligation-endovenous laser ablation-foam sclerotherapy (HL-EVLA-FS) in people with active venous leg ulcers (VLUs). A retrospective cohort study was conducted with 350 patients with active VLUs treated by compression with or without HL-EVLA-FS in our hospital from 2013 to 2017. The primary outcome was the ulcer healing time; secondary outcomes were the 12-month recurrence rates, the relationship between recurrence and venous reflux, and the complications of the two treatments. In total, 193 patients (200 limbs) underwent compression plus HL-EVLA-FS, and 157 patients (177 limbs) underwent CT alone. The ulcer healing time was shorter in the compression plus HL-EVLA-FS group than in the CT alone group (Hazard Ratio [HR] for ulcer healing, 1.845 [95% CI, 1.474–2.309], P = 0.0001). The 12-month ulcer recurrence rates were significantly reduced in the compression plus HL-EVLA-FS group (HR for ulcer recurrence, 0.418 [95% CI, 0.258–0.677], P = 0.0001). Calf perforator vein reflux (CPVR) and isolated superficial venous reflux (ISVR) were risk factors for ulcer recurrence. The combined operation with CT resulted in faster healing of VLUs, a lower ulcer recurrence rate and lower VCSS values after intervention than CT alone.

Effect of foam sclerotherapy on healing and long-term recurrence in chronic venous leg ulcers

2013 ◽  
Vol 28 (3) ◽  
pp. 140-146 ◽  
Author(s):  
S R Kulkarni ◽  
F J A Slim ◽  
L G Emerson ◽  
C Davies ◽  
R A Bulbulia ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Healing Rate ◽  
Leg Ulcers ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Recurrence Rates ◽  
Venous Ulceration ◽  
Venous Leg Ulcers ◽  
Venous Surgery

Introduction The ESCHAR trial showed that superficial venous surgery and compression in chronic venous ulceration achieved a 24-week healing rate of 65% and 12-month recurrence rate of 12%. Foam sclerotherapy treatment is an alternative to surgery. The aim of this study is to assess the effect of foam sclerotherapy on ulcer healing and recurrence in chronic venous leg ulcers. Methods Chronic venous leg ulcers (CEAP [clinical, aetiological, anatomical and pathological elements] 5 and CEAP 6) with superficial venous reflux were treated between March 2006 and June 2011 with ultrasound-guided foam sclerotherapy and compression. Venous duplex was performed on all legs before and after treatment. Twenty-four-week ulcer healing and one- and four-year ulcer recurrence rates were calculated using Kaplan–Meier survival analysis. Results Two hundred legs (186 patients) with chronic venous ulcers (CEAP 5: n = 163 and CEAP 6: n = 37) were treated with foam sclerotherapy. Complete occlusion was achieved in 185/200 (92.5%) limbs, short segment occlusion in 14/200 (7%) limbs and one leg segment failed to occlude. One patient suffered an asymptomatic non-occlusive deep vein thrombosis (DVT) diagnosed on duplex scan at one week and one presented with an occlusive DVT three weeks following a normal scan at one week. One patient developed an asymptomatic occlusive DVT at two weeks following a non-occlusive DVT diagnosed on initial one-week scan. Eighteen patients were lost to follow-up (3 moved away and 15 died of unrelated causes). The 24-week healing rate was 71.1% and one- and four-year recurrence rates were 4.7% and 28.1%, respectively. Conclusion Foam sclerotherapy is effective in abolition of superficial venous reflux and may contribute to similar ulcer healing and long-term recurrence rates to superficial venous surgery. Foam sclerotherapy is an attractive alternative to surgery in this group of patients.

Current clinical evidence on endovenous laser ablation (EVLA) from randomised trials

Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 201-206 ◽  
Author(s):  
K. Rass
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Term Treatment ◽  
High Ligation ◽  
Control Group ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Treatment Approaches ◽  
Long Term Treatment

SummaryBackground Endovenous laser ablation (EVLA) is globally counted among the most frequently administered methods to treat saphenous vein incompetence. Technical development proceeded in three particular steps: EVLA #1 – Diode lasers linearly emitting wavelengths from 810 to 980 nm through optical bare fibres; EVLA #2 – Diode or Nd:YAG lasers emitting wavelengths from 1064 to 1500 nm; EVLA #3 – Modified optical fibres warranting an optimised emission geometry by centralisation of the fibre tip (Tulip-fibre, Jacket-tip) or radial emission of the laser beam. Due to the number of different EVLA techniques their value compared with standard surgery (high ligation and stripping, HLS) and other endovascular approaches has to be questioned.Methods Selective literature analysis based on a systematic PubMed search focussed on randomised controlled trials (RCT) comparing EVLA with HLS and other thermal or nonthermal ablation techniques – radiofrequency ablation (RFA), ultrasound guided foam sclerotherapy (UGFS), endothermal steam ablation (EStA).Results The search terms “endovenous”, “laser”, “varicose vein” resulted in 509 publications, hereof 57 RCTs, hereof 24 randomised studies comparing EVLA with other treatment approaches: 15 studies comprise comparisons with standard surgery and further 9 studies with other endovenous techniques. 6 RCTs contain long-term followup data on EVLA #1 vs. HLS suggesting superiority of HLS in terms of same site clinical and duplex detected recurrence from the groin. 15 RCTs are reporting short-term results clearly demonstrating inferiority of EVLA #1 against EVLA #2, EVLA #3, and RFA with respect to postoperative complaints and patients’ quality of life.Conclusions The first generation endovenous laser systems are disadvantageous or even harmful as compared with more advanced EVLA techniques and RFA in terms of patients’ complaints and side effects. Furthermore, evidence is rising that EVLA #1 is inferior to standard surgery regarding long-term treatment efficacy. Therefore, the application of EVLA #1 in the treatment of saphenous vein incompetence cannot be recommended any longer. In view of the more recently published RCTs reporting long-term superiority of standard surgery, HLS should still be implemented as control group in studies investigating endovenous treatment approaches.

Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers

2015 ◽  
Vol 32 (5) ◽  
pp. 307-315 ◽  
Author(s):  
Mustafa Seren ◽  
Mert Dumantepe ◽  
Osman Fazliogullari ◽  
Suha Kucukaksu
Keyword(s):  
Laser Ablation ◽  
Demographic Data ◽  
Combined Treatment ◽  
Average Energy ◽  
Compression Therapy ◽  
Ulcer Recurrence ◽  
Recurrence Rates ◽  
Endovenous Laser Ablation ◽  
Perforating Veins ◽  
Venous Ulcers

Objective Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent perforating veins (IPVs) on ulcer recurrence rates in patients with progressive lipodermatosclerosis and impending ulceration. Methods Patients with nonhealing venous ulcers of >2 months’ duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Endovenous laser ablation (EVLA) of perforating veins was performed on patients with CEAP 6 disease with increasing hyperpigmentation, lipodermatosclerosis, and/or progressive malleolar pain. A minimum of 2 months of compressive therapy was attempted before endovenous ablation of IPVs. Demographic data, risk factors, CEAP classification, procedural details, and postoperative status were all recorded. Results Forty ulcers with 46 associated IPVs were treated with EVLA in 36 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (85.7%), calf (10.7%), and lateral ankle (3.5%). Endovenous laser ablation was successful in 76% (35/46) with the first laser treatment of incompetent perforator veins and 15.2% (7/46) additional ablation procedures were performed. Of the 46 treated IPVs, 42 (91.3%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 162 joule. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. Conclusion Especially in the case of liposclerotic or ulcerated skin in the affected region, PAP of IPVs is highly effective, safe, and appears to be feasible. Patients with active venous ulcers appear to benefit from EVLA of incompetent perforators in order to reduce the risk of ulcer recurrence.

scholarly journals Deep Venous Reflux Associated with a Dilated Popliteal Fossa Vein Reversed with Endovenous Laser Ablation and Sclerotherapy

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Daniel P. Link ◽  
Jennifer Feneis ◽  
John Carson
Keyword(s):  
Laser Ablation ◽  
Popliteal Fossa ◽  
Venous System ◽  
Popliteal Vein ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Deep Venous System ◽  
Before And After ◽  
Volume Effects

Objective. To report an incidence of reflux in the deep venous system reversed by ablation of a popliteal fossa vein (PFV).Method. A 40-year-old man with pain and swelling in the medial upper calf was found to have an incompetent PFV.Results. Reflux in the femoral and popliteal veins was reversed utilizing endovenous laser ablation and foam sclerotherapy, documented on Duplex studies before and after the intervention. There was also resolution of symptoms.Conclusion. A PFV can be associated with deep venous reflux. Correction of this reflux with ablation of the PFV suggests that his type of reflux is secondary to volume effects of the incompetent popliteal vein.

Catheter-directed foam sclerotherapy for chronic venous leg ulcers

2013 ◽  
Vol 29 (10) ◽  
pp. 688-693 ◽  
Author(s):  
Caroline Williamsson ◽  
Peter Danielsson ◽  
Lennart Smith
Keyword(s):  
Side Effects ◽  
Ulcer Healing ◽  
Venous Ulcer ◽  
Leg Ulcers ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Venous Leg Ulcers ◽  
One Year ◽  
Compression Treatment

Objectives This study presents the results of catheter-directed foam sclerotherapy (CDS) for chronic venous ulcer refractory to compression treatment, four weeks and one year after treatment. Methods In sum, 31 patients (32 limbs) with refractory chronic venous ulcer and duplex-verified superficial insufficiency were offered CDS. CDS was conducted with 10 ml of sclerosant foam of 3% polidocanol. Four weeks and one year after treatment, the patients were evaluated regarding ulcer healing and ultrasound appearance of the saphenous trunk. Results CDS was successfully performed in all patients. After one year, 65% of the ulcers were healed. Only two (6%) recurred. 86% of the treated saphenous trunk were completely occluded, 3% was partly occluded and 10% were recanalised. No serious side effects occurred. Conclusions CDS is one alternative of eliminating superficial venous reflux when treating refractory venous leg ulcers. This study suggests that the treatment is safe and induce a quick ulcer healing.

scholarly journals The Management of Varicose Veins

2015 ◽  
Vol 100 (1) ◽  
pp. 185-189 ◽  
Author(s):  
Fan Lin ◽  
Shiyi Zhang ◽  
Yan Sun ◽  
Shiyan Ren ◽  
Peng Liu
Keyword(s):  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Varicose Veins ◽  
Controlled Study ◽  
High Ligation ◽  
Foam Sclerotherapy ◽  
Current Management ◽  
Endovenous Laser Ablation ◽  
Randomized Controlled ◽  
Better Than

Abstract This study aimed to review the current management modalities for varicose veins. There are a variety of management modalities for varicose veins. The outcomes of the treatment of varicose veins are different. The papers on the management of varicose veins were reviewed and the postoperative complications and efficacy were compared. Foam sclerotherapy and radiofrequency ablation were associated with less pain and faster recovery than endovenous laser ablation and surgical stripping. Patients undergoing endovenous laser ablation and radiofrequency ablation are most likely to have a faster recovery time and earlier return to work in comparison with those undergoing conventional high ligation and stripping. A randomized controlled study in multiple centers is warranted to verify which approach is better than others for the treatment of varicose veins.

scholarly journals Compression Therapy Is Not Contraindicated in Diabetic Patients with Venous or Mixed Leg Ulcer

2020 ◽  
Vol 9 (11) ◽  
pp. 3709
Author(s):  
Giovanni Mosti ◽  
Attilio Cavezzi ◽  
Luca Bastiani ◽  
Hugo Partsch
Keyword(s):  
Treatment Protocol ◽  
Compression Therapy ◽  
Healing Time ◽  
Leg Ulcer ◽  
Venous Disease ◽  
Diabetic Patients ◽  
Leg Ulcers ◽  
Foam Sclerotherapy ◽  
Compression Pressure ◽  
A Minor

The aim of this study was to investigate if compression therapy (CT) can be safely applied in diabetic patients with Venous Leg Ulcers (VLU), even when a moderate arterial impairment (defined by an Ankle-Brachial Pressure Index 0.5–0.8) occurs as in mixed leg ulcers (MLU). Materials and methods: in one of our previous publications we compared the outcomes of two groups of patients with recalcitrant leg ulcers. Seventy-one patients were affected by mixed venous and arterial impairment and 109 by isolated venous disease. Both groups were treated by tailored inelastic CT (with compression pressure <40 mm Hg in patients with MLU and >60 mm Hg in patients with VLU) and ultrasound guided foam sclerotherapy (UGFS) of the superficial incompetent veins with the reflux directed to the ulcer bed. In the present sub analysis of the same patients we compared the healing time of 107 non-diabetic patients (NDP), 69 with VLU and 38 with MLU) with the healing time of 73 diabetic patients (DP), 40 with VLU and 33 with MLU. Results: Twenty-five patients were lost at follow up. The results refer to 155 patients who completed the treatment protocol. In the VLU group median healing time was 25 weeks for NDP and 28 weeks in DP (p = 0.09). In the MLU group median healing time was 27 weeks for NDP and 29 weeks for DP (p = −0.19). Conclusions: when providing leg ulcer treatment by means of tailored compression regimen and foam sclerotherapy for superficial venous refluxes, diabetes has only a minor or no effect on the healing time of recalcitrant VLU or MLU.

Chronic venous leg ulcers: Effects of foam sclerotherapy on healing and recurrence

2014 ◽  
Vol 31 (1) ◽  
pp. 34-41 ◽  
Author(s):  
G Grover ◽  
A Tanase ◽  
A Elstone ◽  
S Ashley
Keyword(s):  
Ulcer Recurrence ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Invasive Treatment ◽  
Recurrence Rates ◽  
Venous Ulceration ◽  
Kaplan Meier ◽  
Before And After ◽  
One Year

Introduction Ultrasound-guided foam sclerotherapy is a minimally invasive treatment option used for ablation of axial and perforator reflux for chronic venous ulceration. Active ulceration presents a significant health burden in both the primary and secondary care setting. The objective of this study is to determine ulcer healing rates at 24 weeks and 12 months, and ulcer recurrence rates at one year for chronic venous ulcers after ultrasound-guided foam sclerotherapy. Methods Between 2007 and 2012, 54 patients underwent ultrasound-guided foam sclerotherapy for clinical, aetiological, anatomical and pathological C6 ulcers. All patients were followed up clinically, and venous duplex was performed on all legs before and after treatment. A prospectively maintained database was analysed to determine venous truncal occlusion rates, 24-week and 12-month healing and recurrence rates (using Kaplan–Meier survival analysis). Results Fifty-seven ulcerated legs, 39 primary and 18 with recurrent superficial venous reflux were analysed. Median time of active ulceration at presentation was 15.2 months (range 5 months to 17 years). At a median follow-up of 2.7 months, 90% (51 legs) achieved full truncal occlusion after one session, 4% (2) short segment occlusion and 5% (3) failed to occlude and one patient died and was lost to follow-up; 13/57 (23%) required a second session of treatment for completion of treatment, recanalisations and to treat perforator disease, 88% (50/57) ulcers healed at a median of 5.3 months (interquartile range 2.9–8.4 months) following their first ultrasound-guided foam sclerotherapy treatment. The 24-week and 12-month estimated healing rates were 53% and 72%, respectively. The estimated 12-month recurrence rate was 9.2%. There were no reported incidences of deep venous thrombosis or neurological symptoms. Conclusion This study affirms the role of ultrasound-guided foam sclerotherapy as a safe and effective option for abolition of superficial reflux.

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