Study Evaluates Endovenous Thermal Ablation for Chronic Venous Insufficiency
June 15, 2017—The Society for Vascular Surgery (SVS) announced the publication of new evidence that suggests that minimally invasive methods to ablate superficial venous reflux in patients with end-stage venous insufficiency are as effective as traditional open venous stripping. Chronic venous insufficiency affects approximately 2.5 million Americans, with up to 20% developing venous ulceration, noted SVS.
The study, “Incidence of Venous Leg Ulcer Healing and Recurrence After Treatment with Endovenous Laser Ablation,” by William A. Marston, MD, et al was published in Journal of Vascular Surgery—Venous and Lymphatic Disorders (2017;5:525–532). The study was conducted by investigators at the University of North Carolina in Chapel Hill, North Carolina. The complete article is available as an open source document from June 15–August 31 at: vsweb.org/Ulcer717.
As noted by SVS, the mainstay of treatment is compression therapy along with evaluation and management of venous reflux. While strategies for treating deep venous reflux are limited, superficial venous reflux, thought to be the etiology of up to 30% of venous ulcers, is considered correctible. Traditional treatment involved open surgical stripping of the saphenous system.
In 2004, the Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial established open surgery as effective in reducing recurrent ulceration. Since that time, minimally invasive techniques to ablate the saphenous system have largely replaced vein stripping and have proven effective in the treatment of venous insufficiency, particularly painful varicose veins (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] class [C] C2 and C3 patients).
In the study, the investigators noted that most patients with leg ulcers and saphenous insufficiency are currently treated with endovenous thermal ablation (EVTA), but little information is available on the long-term results after EVTA in CEAP C5 and C6 patients.
SVS reported that the study was a retrospective evaluation of the results of EVTA performed on 173 limbs with advanced venous insufficiency (CEAP C5 and C6, healed and active ulcers, respectively). Concomitant deep venous insufficiency in this series was 31.2%. With a mean follow-up of 25.2 months, the healing rate was 74% at 6 months, with a recurrence rate of 9% and 29% at 1 and 3 years, respectively.
Comparing these results with those of the ESCHAR trial, Dr. Marston commented in the SVS announcement, “Ulcer healing and recurrence rates appear similar to those of patients treated with surgical stripping.”
The UNC team also found that recurrence was less common in patients with isolated superficial insufficiency as well as those who had phlebectomy performed at the time of the procedure. Given this finding, Marston advised, “Consideration should be given to adding phlebectomy of varicose veins to the initial procedure, particularly if they are directly related to the site of ulceration.” Additionally, physicians should be diligent in evaluating venous insufficiency ulcers, as superficial reflux as a cause is not only common and correctible, but its minimally invasive treatment is also effective, concluded the investigators in the SVS announcement.