Misaki Kiguchi, Eric Hager, Stanley A. Hirsch, Rabih Chaer, Larry Fish, Elizabeth Genovese, Ellen D. Dillavou
University of Pittsburgh Medical Center, Pittsburgh, PA.
OBJECTIVES: Describe and quantify the effects of perforator sclerotherapy on venous ulcers (CEAP 6) without axial reflux.
METHODS: Retrospective analysis of ultrasound (US)-guided perforator injections from January 2010 to November 2012 identified 73 venous ulcers in 62 patients. Patients had no axial reflux. Perforating vein identification and closure were assessed with US. Refluxing perforators near the ulcer were injected with polidocanol foam created in a 4:1 mixture with air. 98.4% of patients had US follow-up performed 2-6 weeks after injection. Ulcers were divided into 2 groups: Group 1 healed ulcer(s); Group 2 either healed and recurred/never healed. All patients were treated with compression therapy. Demographics, comorbidities, treatment details and outcomes were analyzed. p≤0.05 was significant.
RESULTS: Thirty-two patients had healed ulcers; 30 had at least 1 non-healed ulcer. Comparisons of patients with healed vs. non-healed ulcers were: age 60.2 vs. 61.3 years; male gender 50% vs. 60%; history of deep vein thrombosis (DVT) 31.3% vs. 33.3% (p=NS for all). Of the 73 total ulcers, 43 ulcers were healed (Group 1); 30 ulcers recurred/never healed (Group 2) for a healing rate of 59.9%. Initial ulcer size was 3.44cm2 vs. 15.1cm2 (p=NS). One hundred eighty-nine injections were performed with a 53.8% successful closure rate per injection. Successful thrombosis occurred in 68.8% of group 1 vs. 37.8% of group 2 (p<0.001). Group 1 ulcers averaged 2.2 injections per ulcer vs. 2.9 in group 2 (p=0.16). 24.7% of ulcers healed with a single perforator injection. Post procedure DVTs were seen: 5.8% of injections (11/189); 4 in Group 1; 7 in group 2 (p=NS). No other injection complications were seen. 88.1% of Group 1 ulcers had perforator closure at the end of follow-up vs. 67.8% of Group 2 ulcers (p=0.038).
CONCLUSIONS: Successful thrombosis of pathologic perforators with compression therapy increases ulcer healing and was found to be the only predictor of ulcer closure. Perforator closure may require multiple injections and is associated with low DVT rates
AUTHOR DISCLOSURES: R. Chaer: Nothing to disclose; E. D. Dillavou: Nothing to disclose; L. Fish: Nothing to disclose; E. Genovese: Nothing to disclose; E. Hager: Nothing to disclose; S. A. Hirsch: Provensis, Research Grants; M. Kiguchi: Nothing to disclose.
Posted April 2013