Endovenous laser therapy in the treatment of lower-limb venous ulcers.
OBJECTIVE
To assess the efficacy of endovenous laser therapy (EVLT) in the treatment of lower-limb venous ulcers secondary to venous reflux.


METHODS
Forty-four of 139 patients referred for EVLT from January 2004 to August 2007 had nonhealing venous ulcers. Preprocedural duplex ultrasound (US) was performed to document saphenous venous reflux secondary to saphenofemoral/saphenopopliteal junction incompetence, deep venous insufficiency, and deep vein thrombosis. Follow-up intervals were within 1 week, monthly until ulcer healing, and every 6 months thereafter. Mean follow-up period was 35.8 months (range, 8.1-59.3 months).


RESULTS
Mean great saphenous vein (GSV) diameter and length treated were 9.9 mm (range, 5.5-16.0 mm) and 36.7 cm (range, 20.0-60.0 cm). Mean laser energy used was 3,292 J (range, 1,392-4,971 J). Mean energy deposited per centimeter of vein was 93.6 J/cm (range, 45.2-182.0 J/cm). Mean laser time was 232 seconds (range, 99-347 sec). Fifteen patients with follow-up duplex US had no GSV flow at 6 months, with nonvisualization indicating complete obliteration. Ulcer healing occurred as early as 1 week after the procedure in some patients. Cumulative healing rates at 1, 3, 6, and 12 months were 82.1%, 92.5%, 92.5%, and 97.4%, respectively. No ulcer had recurred at 1 year, but ulcers recurred in five patients at 14, 14, 23, 35, and 52 months after EVLT, respectively. One patient with a nonhealing ulcer 2 years after treatment developed well differentiated squamous cell carcinoma.


CONCLUSIONS
Ulcer epithelization occurred with continued GSV occlusion and loss of flow. Most ulcers healed within 3 months with no recurrence at 1 year. Nonhealing ulcers should undergo biopsy to exclude malignant transformation.
Teo
Terence Kiat Beng
TK
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore. tkbteo@yahoo.com.sg
Tay
Kiang Hiong
KH
Lin
Shueh En
SE
Tan
Seck Guan
SG
Lo
Richard H
RH
Taneja
Manish
M
Irani
Farah G
FG
Sebastien
Mathew George
MG
Lim
Kiat Hon
KH
Tan
Bien Soo
BS
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000601:surgery*; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000601:surgery*