Letter regarding the role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis

Abstract

Letter regarding the role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis Dear Editor, I read with interest the paper, ''The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis'' by Ga´bor Martis and Rena´ta Laczik. 1I would like to congratulate the authors on bringing a very useful technique to the literature which mirrors, and greatly adds to, a presentation of our early results of a similar approach that we used to follow and that we presented at the UK Venous Forum in 2000. However, we subsequently moved to a more conservative interventional approach by correcting underlying venous reflux in truncal veins using endovenous thermoablation and in perforating veins using the TRLOP technique.3 Using these endovenous techniques, under local anaesthetic only since 2005, we have reported long-term healing of 85% in these C6 patients, 52% not needing any further compression at all.Similar results have now been reported for endovenous foam sclerotherapy. 4 As the authors of this current study have shown 100% healing at one year with their radical surgery with long post-operative recovery, but simple endovenous techniques performed as ambulatory outpatient procedures as referenced above can show healing in 70 to 85% of the same sort of cases, do the authors think that their radical surgery should be reserved for those 15 to 30% of patients who fail the less invasive and less expensive endovenous techniques?This would lead to a logical treatment strategy for patients with venous leg ulcers starting with minimally invasive ambulatory techniques for patients with reflux in their truncal veins and/or perforating veins, with radical surgery such as the authors described held in reserve for those patients failing this approach.