Phlebology 2004; 19:158

(The official journal of the Venous Forum of the Royal Society of Medicine and Societas Phlebologica Scandinavica, Members of the Union Internationale de Phlebologie)

T.L. Eaton*, B. McDonagh^ , R..C. Guptan‡

*Wisconsin Phlebology Group, Brookfield , Wisconsin, USA , ^Illinois Phlebology Group, Chicago , Illinois , USA and ‡Department of Clinical Research, Venous Research Foundation, Schaumburg , Illinois , USA

Methods: An analysis of 19 patients with non-healing venous leg ulcers (CEAP Class 5 and 6) who presented to our offices. The duration of the ulcers was 4 months to 28 years. Prior therapy has failed in 18 (95%) and one had never been treated. One patient had undergone prior vein surgery and developed their ulcer as a result of a post-operative deep venous thrombosis. A thorough history was obtained on all patients, followed by a detailed clinical examination and Duplex ultrasound venous mapping. Treatment consisted of sequential ultrasound-guided foam sclerotherapy following the COMPASS protocol.

Results: Two (11%) of the 19 patients who underwent the treatment protocol had bilateral ulcers. Complete ulcer healing occurred in 3-16 weeks for 17 (94%) of the patients. Healing was sustained for up to ten years. One recently enrolled patient had not yet healed at eight weeks. One patient developed ulcer recurrence at three years . This healed with one treatment session. No patients had systemic infection. None had significant arterial insufficiency as a contributing factor for their venous ulceration. One patient, having previously failed multiple skin grafts and a latissimus dorsi free flap, never fully healed with COMPASS. This patient elected to have a below knee amputation after three years.

Conclusions: Venous stasis ulcers represent the pathology of the most advanced stage of chronic venous insufficiency (CVI). Confusion surrounds the etiology, diagnosis, and management of this condition. Aggressive intervention is required to normalize venous hemodynamics, promote healing, eliminate pain, reduce the risk of squamous cell carcinoma and prevent unnecessary limb amputation. Compression therapy alone or sub-facial endoscopic perforator surgery (SEPS) has been attempted with variable success. Failure of earlier surgical techniques has been attributed primarily to inadequate detailing of venous pathology, especially incompetent perforators (IP). Less invasive approaches of foam sclerotherapy have demonstrated promising results. More specifically, the COMPASS protocol of detailed venous mapping in conjunction with sequential ultrasound-guided foam sclerotherapy has been shown to be highly efficacious in the management of end-stage chronic venous insufficiency. Unlike varicose vein surgery, this less invasive therapeutic option can provide rapid healing of venous stasis ulcers, prolonged cure and provide improved quality of life.

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