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August 20, 2020

Study Compares Treatments to Improve Healing of Chronic Venous Leg Ulcers

August 20, 2020—The Society for Vascular Surgery (SVS) announced that a multicenter, retrospective, cohort study involving > 800 patients with chronic venous leg ulcers (VLUs) demonstrated the relative impact of various treatment modalities as well as their cumulative effect on healing. The findings were published by Peter F. Lawrence, MD, et al in Journal of Vascular Surgery: Venous and Lymphatic Disorders (2020;8:601-609).

“Venous leg ulceration represents the most severe and debilitating form of chronic venous insufficiency,” commented Dr. Lawrence in the SVS announcement. “Unfortunately, its prevalence may be as high as 1% to 2% of patients over the age of 70.” Dr. Lawrence is with the University of California, Los Angeles in Los Angeles, California.

He continued, “In our study, we found that ulcer size correlated with venous reflux affecting more than one level (perforator, superficial, or deep), and patients having the largest ulcers also had the most significant multilevel disease. Further, large ulcers are not only more complex, but healing is impacted by ulcer duration, depth, frequency of debridement, and quality of wound care.”

According to SVS, Dr. Lawrence led a team of venous specialists from 11 institutions across the United States. The investigators evaluated 832 patients who had been treated with compression therapy for at least 2 months between 2013 and 2017 and determined healing and recurrence rates after various treatment modalities.

SVS outlined the healing and recurrence results for the treatment modalities reported by the investigators in Journal of Vascular Surgery: Venous and Lymphatic Disorders.

  • Conservative measures (compression, wound care) alone (n = 187): healing in 75% at 36 months, recurrence in 15% at 24 months
  • Truncal vein ablation alone (n = 184): healing in 51% at 36 months, recurrence in 19% at 24 months
  • Truncal plus perforating vein ablation (n = 344): healing in 68% at 36 months, recurrence in 18% at 24 months
  • Deep venous stenting (n = 95): healing in 77% at 36 months, recurrence in 27% at 36 months
  • All three procedures (n = 18): healing in 87% at 36 months, recurrence in 24% at 24 months

The investigators concluded that elimination of truncal and perforating venous reflux, along with correction of deep venous obstruction, significantly contributes to the healing of recalcitrant VLUs. They also recommend that evaluation of the deep system for stenosis is often helpful in patients who fail to heal despite correction of superficial venous reflux, stated SVS in the press release.

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