Longer Healing Times, Higher Recurrence Rates, And Increased Incidence Of Dvt Following Cyanoacrylate Ablation For Active Venous Ulcerations

Abstract

INTRODUCTION Venous leg ulcerations are a common ailment with increasing prevalence in older populations, 5% of those over age 65, and cost approximately half a billion dollars per year. With an aging population, venous ulcers represent an increasing burden. Treatment of superficial venous reflux with ablation has been demonstrated to decrease ulcer recurrence, but the relationship between healing active ulcers and ablation remains uncertain, particularly between different modalities of ablation. METHODS Data was collected retrospectively on 146 patients at a single institution, tertiary-referral center, with an active venous ulcer who underwent ablation therapy via cyanoacrylate (Venaseal™), radiofrequency (RFA), or endovenous laser ablation (EVLT) from 2010-2020. The primary outcome was the time to ulcer healing. Secondary outcomes were the rate of recurrence, compliance with compression, and participation in a wound clinic. RESULTS The study showed a non-significant difference in days to ulcer healing post-intervention between ablative techniques, with 80.8 days for cyanoacrylate (n=15), 70.07 for RFA (n=44), and 67.04 days for EVLT (n=79). A similar, non-significant trend was observed for ulcer recurrence, with a rate of 35.7% (5/14) for cyanoacrylate, 26.7% (20/75) for EVLT, and 23.1% (9/39) for RFA. Few local and systemic complications occurred. The most common complication was DVT after procedure (n=13). The same non-significant trend occurred with DVT following procedure, being observed in 12.5% (2/16) of cyanoacrylate, 9.5% (8/84) of EVLT, and 6.5% (3/46) of RFA cases. Logistic regression to predict wound healing was significant for compliance with compression therapy and was not influenced by smoking, diabetes mellitus, or participation in a wound clinic. CONCLUSIONS There is a consistent trend towards longer rates of healing, higher ulcer recurrence, and increased incidence of DVT after cyanoacrylate ablation as compared to RFA and EVLT. Compliance with compression therapy is predictive of ulcer healing for all ablation modalities. Venous leg ulcerations are a common ailment with increasing prevalence in older populations, 5% of those over age 65, and cost approximately half a billion dollars per year. With an aging population, venous ulcers represent an increasing burden. Treatment of superficial venous reflux with ablation has been demonstrated to decrease ulcer recurrence, but the relationship between healing active ulcers and ablation remains uncertain, particularly between different modalities of ablation. Data was collected retrospectively on 146 patients at a single institution, tertiary-referral center, with an active venous ulcer who underwent ablation therapy via cyanoacrylate (Venaseal™), radiofrequency (RFA), or endovenous laser ablation (EVLT) from 2010-2020. The primary outcome was the time to ulcer healing. Secondary outcomes were the rate of recurrence, compliance with compression, and participation in a wound clinic. The study showed a non-significant difference in days to ulcer healing post-intervention between ablative techniques, with 80.8 days for cyanoacrylate (n=15), 70.07 for RFA (n=44), and 67.04 days for EVLT (n=79). A similar, non-significant trend was observed for ulcer recurrence, with a rate of 35.7% (5/14) for cyanoacrylate, 26.7% (20/75) for EVLT, and 23.1% (9/39) for RFA. Few local and systemic complications occurred. The most common complication was DVT after procedure (n=13). The same non-significant trend occurred with DVT following procedure, being observed in 12.5% (2/16) of cyanoacrylate, 9.5% (8/84) of EVLT, and 6.5% (3/46) of RFA cases. Logistic regression to predict wound healing was significant for compliance with compression therapy and was not influenced by smoking, diabetes mellitus, or participation in a wound clinic. There is a consistent trend towards longer rates of healing, higher ulcer recurrence, and increased incidence of DVT after cyanoacrylate ablation as compared to RFA and EVLT. Compliance with compression therapy is predictive of ulcer healing for all ablation modalities.