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Abstract

Objectives

This study presents the results of catheter-directed foam sclerotherapy (CDS) for chronic venous ulcer refractory to compression treatment, four weeks and one year after treatment.

Methods

In sum, 31 patients (32 limbs) with refractory chronic venous ulcer and duplex-verified superficial insufficiency were offered CDS. CDS was conducted with 10 ml of sclerosant foam of 3% polidocanol. Four weeks and one year after treatment, the patients were evaluated regarding ulcer healing and ultrasound appearance of the saphenous trunk.

Results

CDS was successfully performed in all patients. After one year, 65% of the ulcers were healed. Only two (6%) recurred. 86% of the treated saphenous trunk were completely occluded, 3% was partly occluded and 10% were recanalised. No serious side effects occurred.

Conclusions

CDS is one alternative of eliminating superficial venous reflux when treating refractory venous leg ulcers. This study suggests that the treatment is safe and induce a quick ulcer healing.

Keywords

Chronic venous ulcers endovenous technique catheter-directed foam sclerotherapy polidocanol

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References

Nelzen

Bergqvist

Lindhagen

. The prevalence of chronic lower-limb ulceration has been underestimated: results of a validated population questionnaire. Br J Surg 1996; 83: 255–258.

Moffatt

Franks

Oldroyd

. Community clinics for leg ulcers and impact on healing. BMJ 1992; 305: 1389–1392.

Nelzen

. Leg ulcers: economic aspects. Phlebologie 2000; 15: 110–114.

O’Meara

Cullum

Nelson

. Compression for venous leg ulcers. Cochrane Database Syst Rev 2009; 1: CD000265–CD000265.

Barwell

Davies

Deacon

. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet 2004; 363: 1854–1859.

Coleridge-Smith

. Leg ulcer treatment. J Vasc Surg 2009; 49: 804–808.

Obermayer

Göstl

Walli

. Chronic venous leg ulcers benefit from surgery: long-term results from 173 legs. J Vasc Surg 2006; 44: 572–579.

Howard

Kothari

. The role of superficial venous surgery in the management of venous ulcers: a systematic review. Eur J Vasc Endovasc Surg 2008; 36: 458–465.

Barwell

Taylor

Deacon

. Surgical correction of isolated superficial venous reflux reduces long-term recurrence rate in chronic venous leg ulcers. Eur J Vasc Endovasc Surg 2000; 20: 363–368.

10.

Cabrera

Redondo

Becerra

. Ultrasound-guided injection of polidocanol microfoam in the management of venous leg ulcers. Arch Dermatol 2004; 140: 667–673.

11.

Pang

Bate

Darvall

. Healing and recurrence rates following ultrasound-guided foam sclerotherapy of superficial venous reflux in patients with chronic venous ulceration. Eur J Vasc Endovasc Surg 2010; 40: 790–795.

12.

Bergan

Pascarella

Mekenas

. Venous disorders: treatment with sclerosant foam. J Cardiovasc Surg (Torino) 2006; 47: 9–18.

13.

Darvall

Bate

Adam

. Ultrasound-guided foam sclerotherapy for the treatment of chronic venous ulceration: a preliminary study. Eur J Vasc Endovasc Surg 2009; 38: 764–769.

14.

Hertzman

Owens

. Rapid healing of chronic venous ulcers following ultrasound-guided foam sclerotherapy. Phlebology 2007; 22: 34–39.

15.

Parsi

. Catheter-directed sclerotherapy. Phlebology 2009; 24: 98–107.

16.

Kölbel

Hinchliffe

Lindblad

. Catheter-directed foam sclerotherapy of axial saphenous reflux: early results. Phlebology 2007; 22: 219–222.

17.

Williamsson

Danielsson

Smith

. Catheter-directed foam sclerotherapy for insufficiency of the great saphenous vein: occlusion rates and patient satisfaction after one year. Phlebology 2013; 28: 80–85.

18.

Tessari

Cavezzi

Frullini

. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg 2001; 27: 58–60.

19.

Simka

. Principles and technique of foam sclerotherapy and its specific use in the treatment of venous leg ulcers. Int J Low Extrem Wounds 2011; 10: 138–145.

20.

van Gent

Hop

van Praag

. Conservative versus surgical treatment of venous leg ulcers: a prospective, randomized, multicenter trial. J Vasc Surg 2006; 44: 563–571.

21.

Nael

Rathbun

. Effectiveness of foam sclerotherapy for the treatment of varicose veins. Vasc Med 2010; 15: 27–32.

22.

Jia

Mowatt

Burr

. Systematic review of foam sclerotherapy for varicose veins. Br J Surg 2007; 94: 925–936.

23.

Treiman

Copland

McNamara

. Factors influencing ulcer healing in patients with combined arterial and venous insufficiency. J Vasc Surg 2001; 33: 1158–1164.

24.

Bush

. New technique to heal venous ulcers: terminal interruption of the reflux source (TIRS). Perspect Vasc Surg Endovasc Ther 2010; 22: 194–199.

Catheter-directed foam sclerotherapy for chronic venous leg ulcers