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Endovenous laser ablation of great saphenous vein and perforator veins improves venous stasis ulcer healing.
Ann Vasc Surg. 2013 Oct; 27(7):932-9.AV

Abstract

BACKGROUND

We sought to compare the outcomes of endovenous laser ablation (EVLA) of the great saphenous vein (GSV) to EVLA of the GSV and calf incompetent perforator veins (IPVs) in management of venous stasis ulcers (VSUs).

METHODS

A retrospective review of patients with active VSUs (clinical, etiology, anatomy, and pathophysiology [CEAP] classification C6) that received EVLA of the GSV or combined EVLA of the GSV and IPV between May 2005 and May 2010 was completed. Primary outcomes measured include ulcer healing and a change in the venous clinical severity score (VCSS). Secondary end points included complications, ulcer recurrence rate, and time to ulcer healing.

RESULTS

Ninety-five patients (108 limbs) met inclusion criteria with active VSU (CEAP classification C6) before ablation. The average age was 58 years, with a male predominance (61%). Seventy-eight patients (91 limbs) were treated with EVLA of the GSV alone. Subgroup analysis revealed that 46 of 91 limbs (35 patients) had GSV reflux only (group 1) and 45 of 91 limbs (43 patients) had underlying IPV (group 2). Seventeen patients (17 limbs) underwent combined EVLA of the GSV and IPV (group 3). VSU healing (CEAP classification C5) occurred in 21 of 46 limbs (46%) in group 1, 15 of 45 limbs (33%) in group 2, and 12 of 17 limbs (71%) in group 3. A comparison of ulcer healing between groups 1 and 2 and between groups 1 and 3 revealed no significant difference (Fisher's exact test; P = 0.285 and P = 0.095, respectively). However, there was a significant difference in ulcer healing between groups 2 and 3 (P = 0.011). Group 1 ulcers healed in an average of 14.8 weeks, group 2 ulcers in 11.2 weeks, and group 3 in 13.2 weeks (analysis of variance; P = 0.918). Postoperative complications occurred in 7 limbs (15%) in group 1, 5 limbs (11%) in group 2, and 3 (18%) limbs in group 3. Recurrence of VSU occurred in 2 limbs (4%) in group 1, 5 limbs in group 2 (11%), and in no limbs in group 3 (Fisher's exact test; P = 0.676). Mean follow-up was 16.9 weeks for group 1, 19.2 weeks for group 2, and 14.0 weeks for group 3 (P = 0.69).

CONCLUSIONS

Ulcer healing was accomplished to a significantly greater degree using EVLA of the GSV and IPV compared to GSV ablation alone for the treatment of active VSU in patients with combined reflux. This study suggests that limbs with VSU disease should be routinely examined for both superficial axial and perforator venous reflux and, when appropriate, combined ablation of the GSV and IPV should be considered in management of this disease.

Authors+Show Affiliations

Eastern Virginia Medical School, Norfolk, VA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23711972

Citation

Abdul-Haqq, Ryan, et al. "Endovenous Laser Ablation of Great Saphenous Vein and Perforator Veins Improves Venous Stasis Ulcer Healing." Annals of Vascular Surgery, vol. 27, no. 7, 2013, pp. 932-9.
Abdul-Haqq R, Almaroof B, Chen BL, et al. Endovenous laser ablation of great saphenous vein and perforator veins improves venous stasis ulcer healing. Ann Vasc Surg. 2013;27(7):932-9.
Abdul-Haqq, R., Almaroof, B., Chen, B. L., Panneton, J. M., & Parent, F. N. (2013). Endovenous laser ablation of great saphenous vein and perforator veins improves venous stasis ulcer healing. Annals of Vascular Surgery, 27(7), 932-9. https://doi.org/10.1016/j.avsg.2012.09.014
Abdul-Haqq R, et al. Endovenous Laser Ablation of Great Saphenous Vein and Perforator Veins Improves Venous Stasis Ulcer Healing. Ann Vasc Surg. 2013;27(7):932-9. PubMed PMID: 23711972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovenous laser ablation of great saphenous vein and perforator veins improves venous stasis ulcer healing. AU - Abdul-Haqq,Ryan, AU - Almaroof,Babatunde, AU - Chen,Brian L, AU - Panneton,Jean M, AU - Parent,F Noel, Y1 - 2013/05/24/ PY - 2012/05/07/received PY - 2012/08/23/revised PY - 2012/09/04/accepted PY - 2013/5/29/entrez PY - 2013/5/29/pubmed PY - 2014/4/1/medline SP - 932 EP - 9 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 27 IS - 7 N2 - BACKGROUND: We sought to compare the outcomes of endovenous laser ablation (EVLA) of the great saphenous vein (GSV) to EVLA of the GSV and calf incompetent perforator veins (IPVs) in management of venous stasis ulcers (VSUs). METHODS: A retrospective review of patients with active VSUs (clinical, etiology, anatomy, and pathophysiology [CEAP] classification C6) that received EVLA of the GSV or combined EVLA of the GSV and IPV between May 2005 and May 2010 was completed. Primary outcomes measured include ulcer healing and a change in the venous clinical severity score (VCSS). Secondary end points included complications, ulcer recurrence rate, and time to ulcer healing. RESULTS: Ninety-five patients (108 limbs) met inclusion criteria with active VSU (CEAP classification C6) before ablation. The average age was 58 years, with a male predominance (61%). Seventy-eight patients (91 limbs) were treated with EVLA of the GSV alone. Subgroup analysis revealed that 46 of 91 limbs (35 patients) had GSV reflux only (group 1) and 45 of 91 limbs (43 patients) had underlying IPV (group 2). Seventeen patients (17 limbs) underwent combined EVLA of the GSV and IPV (group 3). VSU healing (CEAP classification C5) occurred in 21 of 46 limbs (46%) in group 1, 15 of 45 limbs (33%) in group 2, and 12 of 17 limbs (71%) in group 3. A comparison of ulcer healing between groups 1 and 2 and between groups 1 and 3 revealed no significant difference (Fisher's exact test; P = 0.285 and P = 0.095, respectively). However, there was a significant difference in ulcer healing between groups 2 and 3 (P = 0.011). Group 1 ulcers healed in an average of 14.8 weeks, group 2 ulcers in 11.2 weeks, and group 3 in 13.2 weeks (analysis of variance; P = 0.918). Postoperative complications occurred in 7 limbs (15%) in group 1, 5 limbs (11%) in group 2, and 3 (18%) limbs in group 3. Recurrence of VSU occurred in 2 limbs (4%) in group 1, 5 limbs in group 2 (11%), and in no limbs in group 3 (Fisher's exact test; P = 0.676). Mean follow-up was 16.9 weeks for group 1, 19.2 weeks for group 2, and 14.0 weeks for group 3 (P = 0.69). CONCLUSIONS: Ulcer healing was accomplished to a significantly greater degree using EVLA of the GSV and IPV compared to GSV ablation alone for the treatment of active VSU in patients with combined reflux. This study suggests that limbs with VSU disease should be routinely examined for both superficial axial and perforator venous reflux and, when appropriate, combined ablation of the GSV and IPV should be considered in management of this disease. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/23711972/Endovenous_laser_ablation_of_great_saphenous_vein_and_perforator_veins_improves_venous_stasis_ulcer_healing_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(13)00094-0 DB - PRIME DP - Unbound Medicine ER -