Abstract
We aimed to assess the ulcer healing time and recurrence rates after treatment with compression therapy (CT) with or without high ligation-endovenous laser ablation-foam sclerotherapy (HL-EVLA-FS) in people with active venous leg ulcers (VLUs). A retrospective cohort study was conducted with 350 patients with active VLUs treated by compression with or without HL-EVLA-FS in our hospital from 2013 to 2017. The primary outcome was the ulcer healing time; secondary outcomes were the 12-month recurrence rates, the relationship between recurrence and venous reflux, and the complications of the two treatments. In total, 193 patients (200 limbs) underwent compression plus HL-EVLA-FS, and 157 patients (177 limbs) underwent CT alone. The ulcer healing time was shorter in the compression plus HL-EVLA-FS group than in the CT alone group (Hazard Ratio [HR] for ulcer healing, 1.845 [95% CI, 1.474–2.309], P = 0.0001). The 12-month ulcer recurrence rates were significantly reduced in the compression plus HL-EVLA-FS group (HR for ulcer recurrence, 0.418 [95% CI, 0.258–0.677], P = 0.0001). Calf perforator vein reflux (CPVR) and isolated superficial venous reflux (ISVR) were risk factors for ulcer recurrence. The combined operation with CT resulted in faster healing of VLUs, a lower ulcer recurrence rate and lower VCSS values after intervention than CT alone.
Highlights
An active venous leg ulcers (VLUs) is the highest clinical stage of lower limb chronic venous insufficiency (C6)[1]
We found that Calf perforator vein reflux (CPVR) (HR for ulcer recurrence, 7.734 [95% CI, 1.513 to 39.532], P = 0.014) and isolated superficial venous reflux (ISVR) (HR for ulcer recurrence, 4.070 [95% CI, 1.229 to 13.478], P = 0.0022) were risk factors for ulcer recurrence (Table 3)
The log-rank test was used to compare the influence of the risk factors of CPVR (Fig. 2c) and ISVR (Fig. 2d) on ulcer recurrence in the two groups, and the results showed that the P values were both less than 0.0001
Summary
An active VLU is the highest clinical stage of lower limb chronic venous insufficiency (C6)[1]. CT6,7 and various kinds of surgery (traditional surgery, ultrasound-guided foam sclerotherapy [UGFS]8,9, EVLA10,11 and radiofrequency ablation [RA]12) have good effects on eliminating or reducing superficial venous hypertension and promoting ulcer healing. The study found no difference in ulcer healing time between the two groups Another clinical trial (EVRA ulcer trial)[3] concluded that CT combined with early endovenous ablation treatment could promote ulcer healing, reduce ulcer recurrence and prolong the patients’ ulcer-free time within 1 year after the intervention. The effect of compression combined use of HL-EVLA-FS is to eliminate superficial venous reflux and cure active VLUs, but it is rarely reported.
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