title: Endovenous laser therapy in the treatment of lower-limb venous ulcers.
abstract: 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.
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore. tkbteo@yahoo.com.sg
authors.forename: Terence Kiat Beng
authors.initials: TK
authors.lastname: Teo
authors.forename: Kiang Hiong
authors.initials: KH
authors.lastname: Tay
authors.forename: Shueh En
authors.initials: SE
authors.lastname: Lin
authors.forename: Seck Guan
authors.initials: SG
authors.lastname: Tan
authors.forename: Richard H
authors.initials: RH
authors.lastname: Lo
authors.forename: Manish
authors.initials: M
authors.lastname: Taneja
authors.forename: Farah G
authors.initials: FG
authors.lastname: Irani
authors.forename: Mathew George
authors.initials: MG
authors.lastname: Sebastien
authors.forename: Kiat Hon
authors.initials: KH
authors.lastname: Lim
authors.forename: Bien Soo
authors.initials: BS
authors.lastname: Tan
mesh_terms: 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*