title: Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers.
abstract: OBJECTIVE
  Endovenous closure of incompetent saphenous veins has been reported to facilitate venous ulcer healing; however, there is little information about the effectiveness of perforator ablation (PA) in healing recalcitrant venous ulcers. We report our experience with PA with venous ulcers unresponsive to prolonged compression therapy.
  
  
  METHODS
  Patients with nonhealing venous ulcers of >3 months' duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Patients who had either no saphenous incompetence or persistent ulcers after saphenous ablation underwent PA of incompetent perforating veins >3 mm that demonstrated reflux; initial treatment was performed on the perforator vein adjacent to the ulcer with additional incompetent veins treated if ulcer healing failed.
  
  
  RESULTS
  Seventy-five ulcers with 86 associated incompetent perforating veins were treated with PA in 45 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (61%), calf (37%), and lateral ankle (2%). Initial success of PA, assessed by postprocedure duplex ultrasound, was 58%; repeat ablation was 90% successful and 71% had eventual successful perforator closure. No complications (skin necrosis, infection, or nerve injury) occurred. Failure of ulcer healing with successful perforator closure occurred in 10% and was due to intercurrent illness, patient noncompliance, and patient death due to unrelated causes. Of patients who healed their ulcers, the healing occurred at a mean of 138 days; an average PA of 1.5 incompetent veins per ulcer was required for healing. Ninety percent of ulcers healed when at least one perforator was closed; no ulcer healed without at least one perforator being closed.
  
  
  CONCLUSIONS
  This experience demonstrates both the feasibility and effectiveness of PA for a selected group of patients with venous ulcers who fail conventional therapy with compression.
authors.affiliation: Division of Vascular Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. pflawrence@mednet.ucla.edu
authors.forename: Peter F
authors.initials: PF
authors.lastname: Lawrence
authors.forename: Ali
authors.initials: A
authors.lastname: Alktaifi
authors.forename: David
authors.initials: D
authors.lastname: Rigberg
authors.forename: Brian
authors.initials: B
authors.lastname: DeRubertis
authors.forename: Hugh
authors.initials: H
authors.lastname: Gelabert
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Jimenez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D017115:Catheter Ablation / Q000009:adverse effects; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014647:Varicose Ulcer / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing