The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates

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 cm². Following successful ablation, the healing rate for healed ulcers improved from + 1.0 ± .1 cm²/month to −4.4 ± .1 cm²/month (P > .05). Ulcer healing rate for healed ulcers, based on the last vein ablated, was GSV = 6.4 cm²/month, SSV = 4.8 cm²/month, and PTPV = 2.9 cm²/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.

Conclusion

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.