Document Detail


Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers.
MedLine Citation:
PMID:  21658887     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Endovenous closure of incompetent saphenous veins has been reported to facilitate venous ulcer healing; however, there is little information about the effectiveness of perforator ablation (PA) in healing recalcitrant venous ulcers. We report our experience with PA with venous ulcers unresponsive to prolonged compression therapy.
METHODS: Patients with nonhealing venous ulcers of >3 months' duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Patients who had either no saphenous incompetence or persistent ulcers after saphenous ablation underwent PA of incompetent perforating veins >3 mm that demonstrated reflux; initial treatment was performed on the perforator vein adjacent to the ulcer with additional incompetent veins treated if ulcer healing failed.
RESULTS: Seventy-five ulcers with 86 associated incompetent perforating veins were treated with PA in 45 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (61%), calf (37%), and lateral ankle (2%). Initial success of PA, assessed by postprocedure duplex ultrasound, was 58%; repeat ablation was 90% successful and 71% had eventual successful perforator closure. No complications (skin necrosis, infection, or nerve injury) occurred. Failure of ulcer healing with successful perforator closure occurred in 10% and was due to intercurrent illness, patient noncompliance, and patient death due to unrelated causes. Of patients who healed their ulcers, the healing occurred at a mean of 138 days; an average PA of 1.5 incompetent veins per ulcer was required for healing. Ninety percent of ulcers healed when at least one perforator was closed; no ulcer healed without at least one perforator being closed.
CONCLUSIONS: 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.
Authors:
Peter F Lawrence; Ali Alktaifi; David Rigberg; Brian DeRubertis; Hugh Gelabert; Juan Carlos Jimenez
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Publication Detail:
Type:  Journal Article     Date:  2011-06-12
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-05     Completed Date:  2011-11-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  737-42     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. pflawrence@mednet.ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Ankle Brachial Index
Catheter Ablation* / adverse effects
Chronic Disease
Feasibility Studies
Female
Humans
Los Angeles
Male
Middle Aged
Reoperation
Saphenous Vein / physiopathology,  surgery*,  ultrasonography
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Varicose Ulcer / diagnosis,  etiology,  physiopathology,  surgery*
Venous Insufficiency / complications,  diagnosis,  physiopathology,  surgery*
Wound Healing*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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