Periulcer Foam Sclerotherapy Injection in Chronic Venous Leg Ulcers Using Near-Infrared Laser for Vein Visualization

Abstract

High recurrence and high costs of treatment are the main problems with venous ulcer management. Therefore, it is of utmost importance to target the exact pathological cause. The role of cutaneous microvalves reflux in the pathogenesis of these ulcers has been confirmed. In this study, 20 chronic venous leg ulcers were prospectively subjected to foam sclerotherapy injection into periulcer veins using direct visualization by AccuVein AV400. Patients having infected ulcers, acute deep vein thrombosis, hypercoagulability, Ankle-Brachial Index <0.9, pregnancy, and/or allergy to the sclerosant were excluded. Endpoints included rates of ulcer size reduction, complete healing, ulcer recurrence, and procedure-related complications. Aethoxysklerol 1% was used in all cases to produce foam employing the double-syringe system. The mean reduction in ulcer surface area, postinjection, was 75% after 8 weeks and 91% after 12 weeks. Nineteen ulcers (95%) healed in a median time of 8 weeks, range 3 to 17 weeks. At 1 year of follow-up, 18 patients (90%) were still ulcer-free, while 1 patient’s ulcer (5%) recurred 19 weeks postinjection. No major complications were encountered. Periulcer foam sclerotherapy injection, guided by vein visualization technology, should be one of the main lines of treatment of venous leg ulcers. It offers good results with regard to rapid ulcer healing and low recurrence rate without major risk. Randomized controlled trials are needed to establish these conclusions.

Autologous platelet‐rich plasma injection enhances healing of chronic venous leg ulcer: A prospective randomised study

“…The ideal treatment should, thus, provide effective and rapid ulcer healing with low recurrence rate. Recent guidelines recommend that optimisation of the resistant wound environment should proceed hand in hand with cutaneous venous hypertension eradication 3 through axial saphenous vein ablation 4 and/or reticular or perforator veins foam sclerotherapy 5 or thermal ablation, together with continuous standard compression.…”

Infrared augmented reality device versus standard procedure for peripheral venous catheterisation in children less than 3 years old: A quasi‐experimental cluster randomised controlled trial

“…The vein viewer could be used for rapidly involuting congenital hemangioma diagnosis (AlZahrani et al, 2019). Periulcer foam sclerotherapy injection guided by vein visualisation technology, should be one of the main lines of treatment of venous leg ulcers, offering good results (Kamhawy et al, 2020). Given all these findings, the AccuVeinAV400® investment may be useful in improving patient care.…”

Objective assessment of Platelet‐Rich Plasma (PRP) potentiality in the treatment of Chronic leg Ulcer: RCT on 80 patients with Venous ulcer

“…2 Treatment includes different dressing materials, antimicrobials, and intermittent pneumatic compression. 3 The resistance to healing is related to extra prolongation of inflammatory phase of wound healing, excessive cytokines release, more proteolytic activity, and metalloprotease activity. Furthermore, the pathological condition is associated with decrease in fibrin and disturbance in growth factors leading to marked delay in wound healing.…”

“…Evidently, treatment is often difficult and generally associated with high recurrence rate 2 . Treatment includes different dressing materials, antimicrobials, and intermittent pneumatic compression 3 …”