Ultrasound-guided injection of polidocanol microfoam in the management of venous leg ulcers.
BACKGROUND
Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating surgery) is only possible in a subset of patients with leg ulcers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments.


OBJECTIVE
To evaluate the efficacy and safety of sclerosant in microfoam in treating venous leg ulceration.


METHODS
A retrospective study of medical records, pretreatment and posttreatment color photographs, and echo Doppler in patients with venous leg ulceration. All patients were evaluated at 6 months after therapy, 70% were also evaluated at 2 years, 25% at 3 years, and 14% at 4 or more years after treatment. They were assessed for complete (100%) ulcer healing, time to wound closure, and recurrence.


METHODS
Private vascular surgery clinic in Granada and dermatology department at a hospital in Pamplona, Spain.


METHODS
Over 115 months, 116 consecutive patients (mean age [range], 57 [25-85] years) treated with ultrasound-guided injection of polidocanol microfoam (UIPM).


METHODS
To reduce venous hypertension, UIPM was used to selectively and progressively sclerose sources of incompetence. The number of sessions per patient varied between 1 and 17 (mean, 3.6).


METHODS
Complete ulcer healing, defined as full reepithelialization of the wound with absence of drainage. Recurrence was defined as epithelial breakdown in the healed limb.


RESULTS
At 6-months' follow-up, treatment with UIPM achieved complete healing in 83% of patients (96/116), with median time to healing of 2.7 months; 7 patients were never cured, and 1 patient was lost to follow-up. There were recurrences in 10 patients.


CONCLUSIONS
The use of UIPM to selectively and progressively sclerose incompetent veins produced by venous hypertension is highly effective to achieve a stable ulcer healing with minimal invasion, even in elderly patients. Recurrences are easily treatable with this approach. This technique may become a first-line treatment in the management of leg venous ulcers.
Cabrera
Juan
J
Vascular Surgery Clinic, Granada, Spain.
Redondo
Pedro
P
Becerra
Antonio
A
Garrido
Celia
C
Cabrera
Juan
J
García-Olmedo
María Antonia
MA
Sierra
Alejandro
A
Lloret
Pedro
P
Martínez-González
Miguel A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002626:Chemistry, Pharmaceutical; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007871:Leg Ulcer / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014945:Wound Healing
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols