Endovenous Ablation for the Treatment of Chronic Venous Insufficiency and Venous Ulcerations

Abstract

Chronic venous insufficiency with active or healed ulceration is commonly seen in our academic vein center. In this series, endovenous ablation allowed for excellent healing rates and acceptable recurrent ulcer rates. It is unclear from this small cohort whether the addition of perforator ablation was of benefit in improving venous hemodynamics.

Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers

“…Most investigators have favored correction of the superficial reflux initially by removing or ablating the refluxing saphenous veins and tributaries, since these procedures are relatively simple and effective and will heal many venous ulcers. 2,11,12 When superficial ablation does not result in venous ulcer healing, perforator interruption is usually the next step. Whether it is done with direct surgery, sclerotherapy, subfascial endoscopic perforator surgery (SEPS), or endovenous ablation, the elimination of perforator reflux reduces ambulatory venous hypertension.…”

The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates

“…1,2,3 Recently, the ablation of incompetent perforator veins has also been shown to both facilitate ulcer healing and reduce ulcer recurrence; 4 however, most studies of venous ulcer healing report absolute ulcer healing rates and do not use quantitative methods to evaluate the impact of various interventions on ulcer healing rates. 5,6 Since venous ulcers present with a great range in size, the healing rate, rather than complete healing, is a more precise measure of the impact of therapy. In addition, there is little information about the impact of interruption of various incompetent superficial and perforator veins on venous ulcer healing.…”

Chronic venous disease and venous leg ulcers: An evidence-based update

“…85 When these techniques are compared with flush saphenofemoral ligation with stripping (also referred to as open surgery) or high ligation and stripping, there are fewer complications, less time lost from work, improved quality of life scores, less need for general anesthesia, and similar recurrence rates of VLUs. 86 Evidence from current clinical trials suggests that ultrasound-guided foam sclerotherapy, endovenous laser therapy, and radiofrequency ablation are at least as effective as surgery in treating great saphenous veins.…”