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Online ISSN 1827-1766
Magi G. 1, Agus GB. 2, Antonelli P. 1, Nardoianni V. 1, Sereni O. 1, Bavera PM. 2
1 Angiology and Vascular Surgery Center, S. Giuseppe Hospital, Arezzo, Italy
2 Section of Vascular Surgery and Angiology, Department of Specialist Surgical Sciences, University of Milan, Italy
Aim. Chronic venous insufficiency (CVI) with leg ulcers remains a common and challenging problem and, although conventional treatments have had varying rates of success, long-term improvement of the condition has never been consistently achieved. Many studies emphasize that the majority of patients with venous leg ulcers would benefit from surgery. Therefore, there is an ongoing need for new surgical techniques to overcome the barriers to effective treatment of this problem. Here, we report on recent experiences of treating large numbers of patients with ulcers at two centers of the IEWG (Italian endovenous working group), and present the results of a retrospective analysis of randomized patients treated with endovenous laser (ELT) versus the same number of randomized patients treated with the conventional methods of stripping and/or foam sclerotherapy. Our analysis examines various aspects of the techniques, recovery and recurrence rates.
Methods. 560 consecutive patients with an active and “difficult” venous leg ulcer (CEAP C6), who had previously received medical treatment (with the ulcers showing no sign of improvement after 4 weeks), qualified for the study. 280 were randomized for ELT of the great saphenous vein and/or perforator veins (group A); while 280 were randomized for stripping and/or perforator interruption (group B; 20 of these received foam sclerotherapy). The patients received follow-up care until September 2008, and were evaluated by clinical and color-duplex assessment.
Results. The prevalence of perforating vein reflux was high (42%) and comparable in both groups A and B. Tests were conducted that were considered valid for 226 of the 280 patients in Group A and for 231 of the 280 patients in Group B. Overall, healing times were shorter for Group A. Healing times were significantly shorter for patients in Group A with isolated saphenous reflux and combined saphenous/perforators reflux compared with similarly affected patients in Group B. On the other hand, no significant differences were found in the healing times for patients with isolated perforators reflux in both groups. The percentage of total recurrence was lower in Group A. Almost all recurrences in both groups concerned patients who had combined saphenous and perforators reflux when testing began.
Conclusion. Based on our data and our positive personal experiences of using ELT, particularly in the subgroups with perforating vein reflux, the correction of this reflux with minimally invasive laser surgery can be expected to heal most leg ulcers with primary CVI and reduce the recurrence of ulcers within the first three years after treatment. However, the value of such treatment for saphenous reflux alone remains unclear.