Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers

Abstract

This experience demonstrates both the feasibility and effectiveness of PA for a selected group of patients with venous ulcers who fail conventional therapy with compression.

Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity

“…Mechanism of valve dysfunction of PVs leading to CVI and hemodynamic role of PV has not yet been completely elucidated [13,18,19]. One of the asserted mechanisms of the incompetency is enlargement of the diameter, in which incompetent PVs may serve as the re-entry point for superficial blood flow into DVS of patients with VVs [20,21].…”

“…One of the asserted mechanisms of the incompetency is enlargement of the diameter, in which incompetent PVs may serve as the re-entry point for superficial blood flow into DVS of patients with VVs [20,21]. The other proposed mechanism of incompetency is dysfunction due to irreversible valvular damage [19,21,22]. Irreversible valvular damage of incompetent PVs might be associated with recurrence of VVs after operating SVI; therefore, this type of incompetent PVs may require simultaneous treatment with SVI [19,21,22].…”

“…The other proposed mechanism of incompetency is dysfunction due to irreversible valvular damage [19,21,22]. Irreversible valvular damage of incompetent PVs might be associated with recurrence of VVs after operating SVI; therefore, this type of incompetent PVs may require simultaneous treatment with SVI [19,21,22].…”

“…Residual incompetent PVs associated with failure of treatment and aggressive procedures to manage incompetent PVs have improved the surgical outcome. The experiences gathered in clinical studies have also demonstrated that incompetent PVs are likely to be more important in the development of VVs [2,10,23]; if incompetent PVs can be selectively treated, more satisfactory results could be achieved [19,22]. Several authors suggest treating incompetent PVs in cases of focal swelling, pain, associated VVs, focal skin irritation, discoloration, venous ulceration in the area of the incompetent PVs, clinical severity, etiology, anatomy, and pathophysiology score more than four [24].…”

“…In particular, treatment of incompetent PV is recommended in which the VV is non-saphenous and starts from the periphery of incompetent PV. PVI is important for the development and maintenance of these peripherally located VV [19]. Some patients have enlarged incompetent PVs and severe limb symptoms, including ulceration.…”