Endovenous laser ablation of incompetent calf perforating veins does not prevent recurrence of venous ulcers in patients with post-thrombotic syndrome

Abstract

Aim of the study was to assess efficacy of endovenous laser ablation of incompetent calf perforators in patients with post-thrombotic syndrome in preventing recurrence of venous leg ulcers. Material and methods:We conducted a single-centre prospective randomized study. Patients with healed venous ulcers were randomly assigned either to endovenous laser ablation of incompetent calf perforators together with compression therapy (n = 31), or to compression alone (n = 32). We used a 940 nm laser system and under sonographic control ablated all incompetent perforators in the area of healed ulcers. The primary endpoint of the study was the rate of ulcer recurrence within one year of follow-up. The technical success of laser ablation was assessed by duplex ultrasound 3-5 days and 1 year after the procedure. Results: Puncture and laser ablation of all perforators intended to treat was successful, irrespective of their location and diameter. There were no intraoperative and postoperative complications. The occlusion rate of perforators after 3-5 days was 76.9%. After one year only 17 perforators (18.7%) were still occluded. Venous ulcers recurred in 10 patients (32%) managed with laser ablation and in 11 patients (34%) using compression alone (p = 0.859). After one year in both groups of patients, the mean Venous Clinical Severity Score did not change. Conclusions: Endovenous laser ablation of incompetent perforating veins did not reduce the recurrence of venous ulcers in patients with post-thrombotic syndrome. The technical success of this procedure was low and the majority of incompetent perforating veins reopened within a year.

Clinical meaning of incompetent perforators in the setting of post-thrombotic syndrome commentary

“…In this issue of Phlebological Review Zolotukhin et al [1] present the results of their study on recurrence of venous leg ulcers in post-thrombotic patients after endovenous laser ablation of incompetent lower leg perforators. They have found that not only the recurrence rate of these perforators was very high, but also that the procedure did not reduce the ulcer recurrence.…”