A retrospective cohort study comparing two treatments for active venous leg ulcers

Abstract

Endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced traditional surgery for treatment of varicose veins (VVs) with active venous leg ulcers (VLUs), and multiple combined modes have emerged. A retrospective cohort study was performed to compare the effect of traditional surgery (high ligation and stripping followed with compression [compression plus HL-S]) to high ligation-endovenous laser ablation-foam sclerotherapy followed with compression (compression plus HL-EVLA-FS) on the treatment of active VLUs. Data of active VLUs treated in our center from 2008 to 2017 and followed up for 1 year were analyzed. The intervention measures in the first 5 years were compression plus HL-S, and in the following 5 years were compression plus HL-EVLA-FS. The primary outcome was ulcer healing time. The secondary outcomes were the VVs occlusion and clinical success as assessed by a change in venous clinical severity score (VCSS) and complications. The study included 120 patients and 200 patients treated with HL-S and HL-EVLA-FS, respectively, during 2008 to 2017. The average ulcer healing time were 2.3 ± 2.4 and 1.7 ± 1.7 months, respectively. Significant difference was found in the cumulative ulcers healing rate between the two groups (Hazard ratio [HR] and 95% confidence interval [CI] was respectively 1.458 and 1.140–1.865, P = .0002), but no difference was found in the VVs occlusion (HR and 95% CI was respectively 1.005 and 0.774–1.3071, P = .967). Significant difference occurred in 6 months and 12 months post-operatively in the VCSS change and in the procedure data and some complications between the 2 groups. In conclusion, the treatment of HL-EVLA-FS can accelerate the healing of VLUs, improve the VCSS and present superior procedure data. However, no advantage could be found in the VVs occlusion compared with control group.

Comparative analysis of endovenous laser ablation versus ultrasound‐guided foam sclerotherapy for the treatment of venous leg ulcers

“… 23 , 24 , 43 In a randomized study involving 580 legs with GSV insufficiency, Rasmussen 43 and Lawaetz 24 found that the 5‐year occlusion rate was 25% lower in the UFGS group. These observations are consistent with several other reports on VU patients, where relapse rates in the treatment of VUs with UGFS ranged between 5% and 13% within a year, 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 whereas relapse rates of studies involving EVLA were ranging between 0% and 9%. 37 , 38 , 39 , 40 In a study by Wysong et al, 41 in which 30 patients were treated with EVLA in combination with foam sclerotherapy and/or phlebectomy of incompetent tributaries, no ulcer reoccurrence was observed within a median follow‐up time of 448 days.…”

“…Recently, the use of minimally invasive endovenous interventions, including endovenous laser and foam sclerotherapy, has gained increasing attention due to the lack of open surgical incisions, the possibility to be carried out under local/tumescent anaesthesia and consequently, their lower postoperative morbidity 12,18 . So far, a large series of studies has demonstrated the efficacy of thermal and non‐thermal endovenous techniques in reflux elimination in patients with axial venous reflux 19–30 . However, comparative studies on the different types of endovenous treatments in patients suffering from VUs are scarce.…”

“… 12 , 18 So far, a large series of studies has demonstrated the efficacy of thermal and non‐thermal endovenous techniques in reflux elimination in patients with axial venous reflux. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 However, comparative studies on the different types of endovenous treatments in patients suffering from VUs are scarce.…”

Modern technologies of venous ulcers treatment in elderly population

“…В исследовании H. Ontas не было обнаружено статистической разницы между группами РЧА и ЭВЛК (общая частота окклюзии в обеих группах составила 100%), что позволяет назвать данные методы достаточно эффективными, безопасными и обеспечивающими высокую степень окклюзии просвета сосудов [48]. Исследование 2020 г. рассматривало сравнение эффекта традиционной методики комбинированной флебэктомии (КФЭ), ЭВЛК и склеротерапии [49]. Приоритетным методом оказалось использование ЭВЛК, при котором были выше показатели скорости заживления ВТЯ, VCSS через 6 мес.…”

Venous ulcer healing treated with conventional therapy and adjuvant laser: is there a difference?

“…However, despite the diversity of available treatments, the VU healing process is difficult and prolonged. Therefore, laser therapy, specifically Low-Level Laser Therapy (LLLT), has been used as an adjuvant to conventional treatment to aid in wound tissue repair since it reduces the inflammatory process, favors recapillarization and neoformation of tissue layers, besides increasing collagen and elastic fibers in the healed area (13)(14)(15)(16) . In this perspective, some randomized studies show, through the evaluation of clinical indicators, tissue regeneration and reduction in the size of chronic lesions (vascular and diabetic) when using this type of adjuvant therapy to conventional treatment (17)(18)(19) .…”