Venous Stasis Ulcer

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Phlebology 2005; 20:2

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

B. McDonagh¹, S. Sorenson¹, A. Cohen¹, T. Eaton¹, D.E. Huntley¹, M. Schul¹, C. Martin¹, C. Gray¹, P. Putterman¹, T. King¹, J.L. Harry¹, R.C. Guptan²

¹Illinois Phlebology Group, Chicago, Illinois, USA and ²Department of Clinical Research, Venous Research Foundation, Schaumburg, Illinois, USA

Objectives: Venous stasis ulcer is a major public health problem in the U.S. Subcutaneous endoscopic perforator surgery, tissue graft, hyperbaric oxygen and granulocyte-macrophage colony-stimulating factor therapy have remained experimental. There is a need for effective minimally invasive therapies. Non-elastic, ambulatory, below knee (BK) compression aggressively counters the impact of reflux on venous pump failure and is complemented by sequential duplex ultrasound-guided sclerotherapy.

Methods: Eighteen U.S. centers were studied retrospectively. 1,142 leg ulcer cases from 1984 to 2004 were available. Inclusion: CEAP class 6, evidence of chronic venous insufficiency, photograph, treated with non-elastic, ambulatory, BK compression and sequential duplex ultrasound-guided sclerotherapy. Exclusion: Arterial disease, DM and varicose surgery. Outcomes assessment: CEAP classification, sustained healing (>6 months), DVT and amputation incidence. Comprehensive objective mapping (Phlebology 2003; 4:173-185) was used to quantify reflux.

Results: To date, data from 123 patients is available (62M: 61F). The sexes were comparable in age. The mean duration of ulceration was 4.98 months. Most ulcers, 101 (82%), were in the gaiter area. Non-elastic, BK, ambulatory compression was applied every 2.7 days for 4.7 months. In a majority of active ulcers, 75/103 (73%) showed evidence of healing after compression. After 5 sclerotherapy treatments 86/103 (83%) had sustained healing. None had DVT or required amputation at the last follow up but 23/103 (22%) had recurrent reflux, which required sequential duplex ultrasound-guided sclerotherapy.

Conclusion: Non-elastic, BK, ambulatory compression with sequential duplex ultrasound-guided sclerotherapy appears to be highly efficacious in venous stasis ulcer management. A detailed survey is planned to estimate long-term outcomes.

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