Early Versus Deferred Endovenous Superficial Venous Treatment in Patients with Varicose Trophic Ulcers

Abstract

Introduction: Venous leg ulceration (VLU) is one of the most predominate medical disorders worldwide and in the western hemisphere it affects around 1-2% of the general population and up to 5% of the elderly population. Furthermore, the current evidence does not support conclusively the advantage of early endovenoussuperficial venoustreatment (ESVT) compared with deferred treatment for healing or compression therapy alone. Aim: To evaluate the effectiveness of early endovenoussuperficial venoustreatment in comparison with deferred treatment. Methods: The prospective study of 82 patients with VLU who undergoing endovenous varicose veins ablation at the AngioLife Vascular Center, Zaporizhzhya, Ukraine from April 2016 to March 2019 has been performed. All patients were divided into two groups: the main - 42 patients and the control group - 40 patients. The average age of the patients was 56.7±6.4 years. In the main group (n = 42), the endovenous procedure was performed during the first 14±7.4 days after the initial examination, in the control group (n = 40) endovenous procedure was performed in 60±12.3 days after the conservative treatment. All patients have been examined using medical history, physical examination, DUS, and digital photographs. It was taken a plant flora from trophic ulcer, designed compression stocking 2nd class compression, prescribing drugs: diosmin 600 mg once a day. Patient follow-up visits were performed at 30, 60, 180 days and one year after the initial visit. Results: As a result of comprehensive treatment in 97.5% of patients with VLU completely healedduring the year, but there were some differences, particulary in terms of healing and symptoms of CVD dynamics depending on how fast the endovenoussuperficial venoustreatment has been provided (image1). In 22 patients (52.3%) of the main group, VLU were completely healing within 1 month after early ESVT, in the control group complete VLU healing duringthe first month observation was noted only in 5 patients (12.5 %). The dynamics of VLU healing is shown in Table 1. In the period from the 1st to the 3rd observation month in the main group, complete healing was noted in 15 patients (35.7%) versus 11 patients (27.5) control group. In the period from the 3rd till 6th month, was recorded the final VLU healing in 5th patients (11.9%) main group, against 17 patients (42.5%) from control group (p< 0.05). As a result of treatment, the severity of chronic venous insufficiency symptoms has been steady decreased in both groups (p< 0.05). However, in the main group, the maximum CVD symptoms intensity reduction was noted at the first month of treatment, whether in the control group it was occurred after the 5th month. Conclusion: Early endovenoussuperficial venousablation is an effective, safe and affordable method of treatment for patients with varicose trophic ulcers. Limitations of this study include lack of a control arm or a standardized intervention. In addition, data were not collected on the size of the ulcer and it is possible that small ulcers of short duration may have healed with continued compression and conservative treatment alone. Further randomized controlled studies are needed to confirm these findings. Disclosure: Nothing to disclose