ABSTRACT
OBJECTIVES: The aim was to assess vein recanalisation and ulcer recurrence in patients with chronic venous ulceration following ultrasound-guided foam sclerotherapy. METHOD: Open (CEAP 6) or recently healed (CEAP 5) chronic venous leg ulcers were treated with foam sclerotherapy between July 2010 and August 2012. Venous duplex scans were performed two weeks and one and two years post treatment, recording recanalisation and reflux. One- and two-year ulcer recurrence rates were calculated using Kaplan-Meier survival analysis. RESULTS: A total of 100 legs were treated in 92 patients; 86 were CEAP 5 and 14 were CEAP 6. At two weeks complete or short segment occlusion was demonstrated in 99/100 legs. Complete follow-up was 93% at one year and 88% at two years. Complete and segmental recanalisation with new reflux was recorded in 11/93 (12%) legs and 25/93 (27%) legs, respectively (overall 36/93; 39%) at one year; and 6/88 (7%) legs and 15/88 (17%) legs, respectively (overall 21/88; 24%) at two years. Kaplan-Meier survival analysis shows 64% ulcers healed at 24 weeks and 86% at one year. Ulcer recurrence rate at one and two years was 2.3% and 5.1%. CONCLUSIONS: Over one-third of superficial veins treated with foam sclerotherapy recanalised at one year and just under a quarter of superficial veins recanalised at two years. Despite this, ulcer recurrence rates were low, and recanalisation failed to predict recurrence.
Subject(s)
Sclerotherapy , Ultrasonography , Varicose Ulcer , Aged , Chronic Disease , Disease-Free Survival , Female , Humans , Male , Recurrence , Survival Rate , Varicose Ulcer/diagnostic imaging , Varicose Ulcer/mortality , Varicose Ulcer/therapyABSTRACT
BACKGROUND: Chronic venous leg ulceration can be managed by compression treatment, elevation of the leg, and exercise. The addition of ablative superficial venous surgery to this strategy has not been shown to affect ulcer healing, but does reduce ulcer recurrence. We aimed to assess healing and recurrence rates after treatment with compression with or without surgery in people with leg ulceration. METHODS: We did venous duplex imaging of ulcerated or recently healed legs in 500 consecutive patients from three centres. We randomly allocated those with isolated superficial venous reflux and mixed superficial and deep reflux either compression treatment alone or in combination with superficial venous surgery. Compression consisted of multilayer compression bandaging every week until healing then class 2 below-knee stockings. Primary endpoints were 24-week healing rates and 12-month recurrence rates. Analysis was by intention to treat. FINDINGS: 40 patients were lost to follow-up and were censored. Overall 24-week healing rates were similar in the compression and surgery and compression alone groups (65% vs 65%, hazard 0.84 [95% CI 0.77 to 1.24]; p=0.85) but 12-month ulcer recurrence rates were significantly reduced in the compression and surgery group (12% vs 28%, hazard -2.76 [95% CI -1.78 to -4.27]; p<0.0001). Adverse events were minimal and about equal in each group. INTERPRETATION: Surgical correction of superficial venous reflux reduces 12-month ulcer recurrence. Most patients with chronic venous ulceration will benefit from the addition of simple venous surgery.
Subject(s)
Bandages , Varicose Ulcer/therapy , Veins/surgery , Aged , Aged, 80 and over , Chronic Disease , Combined Modality Therapy , Female , Humans , Leg/blood supply , Male , Middle Aged , Postoperative Complications , Recurrence , Saphenous Vein/surgery , Ultrasonography, Doppler, Color , Varicose Ulcer/surgery , Venous Insufficiency/diagnostic imaging , Venous Insufficiency/physiopathology , Venous Insufficiency/surgeryABSTRACT
The presence of devitalized tissue in a wound is a common problem facing practitioners and is regarded by many as a major inhibitory factor in the wound-healing process and can act as a focus for microbial proliferation. Therefore, for wound healing to proceed in a logical and ordered fashion, it follows that any necrotic material should be cleared from the wound bed. Wound bed preparation is now recognized as crucial to facilitating ordered restoration and regeneration of damaged tissue. However, there is a clear lack of good clinical evidence to support available wound debridement options, particularly for chronic ulcers of the lower extremities. This article reviews the debridement options available to practitioners and discusses rationales for treatment and implications for clinical practice with specific reference to chronic venous leg ulcer management.