title: The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates.
abstract: OBJECTIVE
  We assessed the impact of endovenous ablation of incompetent superficial (great saphenous [GSV] and small saphenous [SSV]) and perforator (posterior tibial [PTPV]) veins on the healing rate of venous ulcers in patients who had failed conventional compression therapy.
  
  
  METHODS
  Patients with CEAP 6 ulcers were treated with weekly compression in a dedicated wound care center. Ulcer size and depth were tracked prospectively. Those ulcers that showed no measurable improvement after >5 weeks of compression therapy underwent ablation of at least one incompetent vein.
  
  
  RESULTS
  We performed 140 consecutive endovenous ablation procedures (74 superficial and 66 perforator) on 110 venous ulcers in 88 limbs. Ulcers had been present for 71 ± 6 months with an initial ulcer area of 23 ± 6 cm(2). Following successful ablation, the healing rate for healed ulcers improved from + 1.0 ± .1 cm(2)/month to -4.4 ± .1 cm(2)/month (P > .05). Ulcer healing rate for healed ulcers, based on the last vein ablated, was GSV = 6.4 cm(2)/month, SSV = 4.8 cm(2)/month, and PTPV = 2.9 cm(2)/month. After a minimum observation period of 6 months (mean follow up, 12 ± 1.25 months), 76.3% of patients healed in 142 ± 14 days. Twelve patients with 26 ulcers did not heal: two patients died from unrelated illnesses, six patients are still actively healing, and four patients have been lost to follow up. Of the healed ulcers, four patients with six ulcers (7.1%) recurred; two have rehealed.
  
  
  CONCLUSIONS
  There is measurable and significant reduction in ulcer size and ultimate healing following ablation of incompetent superficial and perforator veins in patients who have failed conventional compression therapy.
authors: University of San Diego, San Diego, CA, USA.
authors: Michael
authors: M
authors: Harlander-Locke
authors: Peter F
authors: PF
authors: Lawrence
authors: Ali
authors: A
authors: Alktaifi
authors: Juan Carlos
authors: JC
authors: Jimenez
authors: David
authors: D
authors: Rigberg
authors: Brian
authors: B
authors: DeRubertis
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015141:Los Angeles; D008297:Male; D011312:Pressure; D011446:Prospective Studies; D012008:Recurrence; D012501:Saphenous Vein / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000473:pathology / Q000601:surgery*; D014648:Varicose Veins / Q000473:pathology / Q000601:surgery*; D014945:Wound Healing