Five Year Ulcer Recurrence Following Foam Sclerotherapy

Abstract

Introduction: Long term data from the ESCHAR study demonstrated that superficial venous surgery reduces the risk of ulcer recurrence to 12% at one year and 31% at four years. As ultrasound guided foam sclerotherapy (UGFS) is an attractive alternative to surgery, the aim of this study was to assess long-term ulcer recurrence and recanalisation rates following UGFS. Methods: Open (CEAP 6) or recently healed (CEAP 5) chronic venous leg ulcers were treated with UGFS between July 2010 and August 2012. One, two, three, four and five-year ulcer recurrence rates were calculated using Kaplan-Meier survival analysis. Venous Duplex scans were performed at two weeks and annually for five years. Recanalisation was classified as ‘complete’ when the lumen was patent in a previously occluded vein and ‘segmental’ when there was a reduction in the length of occlusion. Results: A total of 100 limbs were treated in 92 patients; 86 were CEAP 5 and 14 were CEAP 6. At two weeks, complete or short segment occlusion was demonstrated in 99/100 legs. Complete follow-up was 93%, 88%, 82%, 74% and 68% at one, two, three years, four and five years respectively. Kaplan-Meier survival analysis showed ulcer recurrence rates at one, two, three, four and five years as 2.3%, 5.1%, 11.3%, 12.2% and 18.4% respectively. Up to five years: 40% of legs remained occluded; 20% demonstrated complete recanalisation with reflux and 40% demonstrated segmental recanalisation with reflux. Ulcer recurrence was demonstrated in 21% and 14% of legs demonstrating complete recanalisation and segmental recanalisation respectively at five years, with 16% in legs remaining occluded (p=n.s, Chi-Squared test). Conclusion: Long term ulcer recurrence rates were low in this study, and whilst recanalisation of the treated veins was common, it did not predict long term ulcer recurrence.