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Introduction. Venous ulcers are often intractable. Objective. The aim of this study was to retrospectively analyze the effectiveness of endovenous ablation, compression therapy, moist wound healing, and skin care in the management of venous ulcers. Materials and Methods. Twenty-eight consecutive patients (10 male, 18 female; mean age, 70.1 years) with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class C6 venous ulcer underwent endovenous ablation between December 2014 and August 2020. The main treatment strategies were radiofrequency ablation and varicectomy (including stab avulsion of incompetent perforating veins), use of compression therapy until complete healing was achieved, moist wound healing (washing the ulcer site and covering it with dressings twice daily), and skin care, taking into consideration the balance of the microbiome. Results. Active venous leg ulcers (CEAP class C6) were diagnosed in 36 patients at the first visit. In 7 of these patients, compression therapy and use of strategies to promote moist wound healing resulted in ulcer healing by the day of the planned surgery. One patient was unable to quit smoking and, therefore, could not undergo surgery. After excluding these 8 patients, the authors analyzed the data from 28 patients who underwent endovenous ablation. The mean surgical time was 38.9 minutes, and the mean number of stab avulsion incision sites was 9.7. All ulcers healed within a median of 55.5 days (range, 13–365 days). Ulcer healing was achieved by 1 year in all 28 patients (100%). No ulceration recurred as of the final follow-up (median, 24.5 months [range, 3–66 months]). Conclusions. Endovenous ablation, adequate varicectomy (stab avulsion [maximum number of sites in 1 patient, 43]), compression therapy, moist wound healing, and skin care are effective in treating and preventing recurrence of venous ulcers.

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Objective We evaluated the benefit of local anesthesia including tumescent anesthesia and active walking soon after surgery in preventing nerve injury and deep vein thrombosis caused during endovenous ablation. Methods Endovenous ablation was performed in 1334 consecutive patients. Varicectomy was performed using the stab avulsion technique. After surgery, patients were encouraged to walk 100–200 m inside the ward for 3–5 times/h. The pain was evaluated objectively using the Okamura pain scale and subjectively using the numerical rating scale. Results Stab avulsion was performed at 11.8 ± 8.0 sites and the mean operative time was 33.9 ± 15.2 min. The mean Okamura pain scale and numerical rating scale scores were 1.6 ± 1.3 and 3.0 ± 2.0, respectively. Deep vein thrombosis and pulmonary embolism were absent. The incidence of nerve injury was 0.3%. Conclusions Endovenous ablation should be performed with the patients under local anesthesia to prevent nerve injury and deep vein thrombosis.

An appropriate strategy is necessary to prevent nerve injury and deep vein thrombosis (DVT) in endovascular ablation (EVA). (Objective) We evaluated the benefit of local anesthesia and active walking as soon as possible after surgery for preventing complications. (Methods) In 439 consecutive patients (146 male and 293 female patients), EVA was performed between December 2014 and December 2016. The mean patient age was 65.0±11.3 years. The surgery was performed under local anesthesia in one leg, and the patients were hospitalized for 2 days and 1 night. The distal one-third of the GSV of the lower limb was marked for the prevention of saphenous nerve injury. Varicectomy was performed using the stab avulsion method. EVA guidelines were applied strictly for DVT prevention. After surgery, 4-5 walking sessions of 200 m/h were promoted. Pain was evaluated using the Okamura pain scale (OPS, score 0-5) objectively and the numerical rating scale (NRS, score 0-10) subjectively. (Results) In all patients, the mean TLA volume was 615.9±153.4 mL, stab avulsion was 12.3±8.3 sites, and operative time was 39.2±15.2 min. All patients could walk as soon as possible after surgery. In 164 recent patients, the mean OPS score was 1.8±1.3 and the mean NRS score was 3.2±2.0. DVT and pulmonary embolism were not noted. (Conclusion) EVA should be performed under local anesthesia to prevent nerve injury and DVT. In addition, adequate walking is important as soon as possible after surgery.