15 - Foam treatment of venous leg ulcers: The initial experience

Abstract

This chapter describes the initial experience using ultrasound-guided microfoam sclerotherapy in the management of ulcer healing. Venous leg ulceration is a widespread and debilitating chronic condition. It is most commonly observed in the elderly but can also affect young adults. Slow healing, pain, and frequent ulcer recurrence characterize it. The pain is characteristically worse at night, limits mobility and leisure activities, and disturbs sleep. Bandages and dressings are often malodorous, contributing to the depression and social isolation that can be experienced by sufferers. Most patients describe the pain, which is greater with larger ulcer size, as the symptom with most impact on their quality of life. Venous hypertension (VH) is the underlying cause of venous ulceration (VU), although the pathogenic steps involved are not fully understood. The pathophysiology of venous ulcers is centered on a hemodynamic dysfunction that may involve superficial, perforator, or deep veins together or separately and is frequently compounded by immobility. The following mechanisms have been implicated: dysfunction of valves in superficial and/or perforator veins due to congenital or acquired incompetence; dysfunction of valves in the deep system due to congenital absence or thrombotic damage; deep venous outflow obstruction; and muscle dysfunction leading to calf muscle pump failure.