Ultrasound-Guided Injection of Polidocanol Microfoam in the Management of Venous Leg Ulcers

Abstract

Background: Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating surgery) is only possible in a subset of patients with leg ulcers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments.Objective: To evaluate the efficacy and safety of sclerosant in microfoam in treating venous leg ulceration.Design: A retrospective study of medical records, pretreatment and posttreatment color photographs, and echo Doppler in patients with venous leg ulceration. All patients were evaluated at 6 months after therapy, 70% were also evaluated at 2 years, 25% at 3 years, and 14% at 4 or more years after treatment. They were assessed for complete (100%) ulcer healing, time to wound closure, and recurrence. Setting: Private vascular surgery clinic in Granada and dermatology department at a hospital in Pamplona, Spain. Patients: Over 115 months, 116 consecutive patients (mean age [range], 57 [25-85] years) treated with ultra-sound-guided injection of polidocanol microfoam (UIPM).Interventions: To reduce venous hypertension, UIPM was used to selectively and progressively sclerose sources of incompetence. The number of sessions per patient varied between 1 and 17 (mean, 3.6).Main Outcome Measures: Complete ulcer healing, defined as full reepithelialization of the wound with absence of drainage. Recurrence was defined as epithelial breakdown in the healed limb.Results: At 6-months' follow-up, treatment with UIPM achieved complete healing in 83% of patients (96/116), with median time to healing of 2.7 months; 7 patients were never cured, and 1 patient was lost to follow-up. There were recurrences in 10 patients. Conclusions:The use of UIPM to selectively and progressively sclerose incompetent veins produced by venous hypertension is highly effective to achieve a stable ulcer healing with minimal invasion, even in elderly patients. Recurrences are easily treatable with this approach. This technique may become a first-line treatment in the management of leg venous ulcers.

Changing Concept on Vascular Malformation: No Longer Enigma

“…56,57,[59][60][61] Our experience with 1% polidocanol foam was also excellent although limited to the localized VM lesions with high risk of skin/mucosa necrosis by ethanol sclerotherapy. Although the recurrence is high as expected, it is particularly recommendable for the lesion with proximity to the skin/oral mucosa with/without transdermal extension to avoid the risk of tissue/skin necorsis.…”

Applications of Polidocanol in Varicose Vein Treatment Assisted by Exposure to Nd:YAG Laser Radiation

“…PEM is a pharmaceutical form of micro-foam that emulates the foam originally produced and studied by Cabrera (Cabrera et al, 2000(Cabrera et al, , 2003(Cabrera et al, , 2004 in a standardized way. It is generated and dispensed using a pressurized canister mechanism depicted in Fig.…”

Prevention of recurrent venous ulceration

“…The former approach involves surgical procedures such as the correction of hemodynamic disorders, or less invasive vascular sclerotherapy and obliteration [26][27][28]. The efficiency of various methods is variable, depending on the technique of surgery and the type and extent of venous insufficiency.…”