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Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation.
J Vasc Surg Venous Lymphat Disord. 2017 07; 5(4):525-532.JV

Abstract

BACKGROUND

The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial previously reported that patients with venous leg ulcers treated with saphenous stripping experienced a significantly reduced incidence of ulcer recurrence compared with patients treated with compression therapy. Most patients with leg ulcers and saphenous insufficiency are currently treated with endovenous thermal ablation (EVTA), but little information is available on the long-term results after EVTA in Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class 5 (C5) and class 6 (C6) patients.

METHODS

We retrospectively reviewed all CEAP C5 or C6 patients treated with EVTA to define the incidence of ulcer healing and recurrence. Patients with active ulcers were managed weekly in a comprehensive wound center until healed. After healing, patients were treated with compression stockings and returned at 6-month intervals for follow-up. Time to healing and time to ulcer recurrence were determined by Kaplan-Meier survival analysis. Risk factors were assessed to determine their association with ulcer recurrence.

RESULTS

EVTA of the great saphenous vein (n = 146), small saphenous vein (n = 20), or both (n = 7) was performed on 173 limbs with active (n = 72) or healed (n = 101) ulcers. Deep venous insufficiency was present in 54 cases (31.2%). Concomitant phlebectomy was performed in 59 limbs (34%). Median follow-up time was 25.2 months after EVTA. Venous ulcers healed after EVTA in 57% of cases at 3 months, 74% at 6 months, and 78% at 12 months. Ulcers recurred in 9% of patients at 1 year after EVTA, 20% at 2 years, and 29% at 3 years of follow-up. Ulcers recurred significantly more often in patients with deep venous insufficiency and in patients who did not undergo phlebectomy of associated varicose veins at the time of EVTA.

CONCLUSIONS

Ulcers recurred in a minority of CEAP clinical C5 and C6 patients after EVTA of the saphenous veins. Ulcer recurrence was less frequent in patients without concomitant deep venous reflux and in those treated with phlebectomy of varicose veins at the time of EVTA. We suggest consideration of phlebectomy at the time of EVTA for patients with C5 and C6 venous insufficiency, particularly in those with isolated superficial venous insufficiency.

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Authors+Show Affiliations

Marston WA
Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: william_marston@med.unc.edu.
Crowner J
Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
Kouri A
Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
Kalbaugh CA
Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.

MeSH

AgedFemaleFemoral VeinFollow-Up StudiesHumansIncidenceLaser TherapyMaleMiddle AgedNorth CarolinaRecurrenceRetrospective StudiesSaphenous VeinStockings, CompressionTime FactorsTreatment OutcomeVaricose UlcerVaricose VeinsWound Healing

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28623990

Citation

Marston, William A., et al. "Incidence of Venous Leg Ulcer Healing and Recurrence After Treatment With Endovenous Laser Ablation." Journal of Vascular Surgery. Venous and Lymphatic Disorders, vol. 5, no. 4, 2017, pp. 525-532.
Marston WA, Crowner J, Kouri A, et al. Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation. J Vasc Surg Venous Lymphat Disord. 2017;5(4):525-532.
Marston, W. A., Crowner, J., Kouri, A., & Kalbaugh, C. A. (2017). Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation. Journal of Vascular Surgery. Venous and Lymphatic Disorders, 5(4), 525-532. https://doi.org/10.1016/j.jvsv.2017.02.007
Marston WA, et al. Incidence of Venous Leg Ulcer Healing and Recurrence After Treatment With Endovenous Laser Ablation. J Vasc Surg Venous Lymphat Disord. 2017;5(4):525-532. PubMed PMID: 28623990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation. AU - Marston,William A, AU - Crowner,Jason, AU - Kouri,Ana, AU - Kalbaugh,Corey A, Y1 - 2017/05/12/ PY - 2016/07/20/received PY - 2017/02/17/accepted PY - 2017/6/19/entrez PY - 2017/6/19/pubmed PY - 2018/7/28/medline SP - 525 EP - 532 JF - Journal of vascular surgery. Venous and lymphatic disorders JO - J Vasc Surg Venous Lymphat Disord VL - 5 IS - 4 N2 - BACKGROUND: The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial previously reported that patients with venous leg ulcers treated with saphenous stripping experienced a significantly reduced incidence of ulcer recurrence compared with patients treated with compression therapy. Most patients with leg ulcers and saphenous insufficiency are currently treated with endovenous thermal ablation (EVTA), but little information is available on the long-term results after EVTA in Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class 5 (C5) and class 6 (C6) patients. METHODS: We retrospectively reviewed all CEAP C5 or C6 patients treated with EVTA to define the incidence of ulcer healing and recurrence. Patients with active ulcers were managed weekly in a comprehensive wound center until healed. After healing, patients were treated with compression stockings and returned at 6-month intervals for follow-up. Time to healing and time to ulcer recurrence were determined by Kaplan-Meier survival analysis. Risk factors were assessed to determine their association with ulcer recurrence. RESULTS: EVTA of the great saphenous vein (n = 146), small saphenous vein (n = 20), or both (n = 7) was performed on 173 limbs with active (n = 72) or healed (n = 101) ulcers. Deep venous insufficiency was present in 54 cases (31.2%). Concomitant phlebectomy was performed in 59 limbs (34%). Median follow-up time was 25.2 months after EVTA. Venous ulcers healed after EVTA in 57% of cases at 3 months, 74% at 6 months, and 78% at 12 months. Ulcers recurred in 9% of patients at 1 year after EVTA, 20% at 2 years, and 29% at 3 years of follow-up. Ulcers recurred significantly more often in patients with deep venous insufficiency and in patients who did not undergo phlebectomy of associated varicose veins at the time of EVTA. CONCLUSIONS: Ulcers recurred in a minority of CEAP clinical C5 and C6 patients after EVTA of the saphenous veins. Ulcer recurrence was less frequent in patients without concomitant deep venous reflux and in those treated with phlebectomy of varicose veins at the time of EVTA. We suggest consideration of phlebectomy at the time of EVTA for patients with C5 and C6 venous insufficiency, particularly in those with isolated superficial venous insufficiency. SN - 2213-3348 UR - https://www.unboundmedicine.com/medline/citation/28623990/Incidence_of_venous_leg_ulcer_healing_and_recurrence_after_treatment_with_endovenous_laser_ablation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-333X(17)30140-3 DB - PRIME DP - Unbound Medicine ER -