Background
Chronic venous ulcer (CVU) is responsible for significant healthcare expenditure worldwide. Compression therapy is the mainstay of treatment, but long-term compliance with this therapy is difficult. Surgery for axial and perforator reflux has been used as an adjuvant to compression to fasten healing and reduce recurrence rates. The treatment of varicose veins has also undergone dramatic changes with the introduction of percutaneous endovenous ablation techniques, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS). The role of these techniques in the treatment of CVU is just beginning to be defined.
Patients and methods
Sixty-six patients with CVU with 71 active leg ulcers who presented at our vascular clinic were included in this study. All patients underwent duplex scanning for venous insufficiency. Ulcer dimensions at each visit were recorded and used to calculate healing rates. The presence or absence of ulcer recurrence at 1-year follow-up was recorded. Ulcers treated with compression alone (the ‘compression group’) were compared with those treated with compression and minimally invasive interventions, such as RFA of superficial axial reflux and UGFS of incompetent perforating veins and varicosities (the ‘intervention group’).
Results
The average age in the intervention and compression groups was 36.7 and 41 years, respectively ( = NS). Ulcers were recurrent in 41.7% of the patients in the intervention group and in 25.5% of patients in the compression group ( = NS). In the intervention group 14.7% underwent RFA of the axial reflux, 38.2% underwent UGFS of perforators, and 41.1% underwent both treatments. The only complication of intervention was a single case of cellulitis requiring hospitalization. No significant difference ( = 0.73) was seen in the proportion of ulcers that did not heal within 24 weeks (24.3% compression vs. 17.5% intervention). Within 1 year a significantly higher rate of recurrence was seen in the compression group compared with the intervention group (46 vs. 20.5%; = 0.004).
Conclusion
Minimally invasive ablation of superficial axial and perforator vein reflux in patients with active CVU is safe and leads to faster healing and decreased ulcer recurrence when combined with compression alone in the treatment of CVU.