Ablation length, not modality type, determines healing outcomes in venous leg ulcers

Abstract

Objective: Early endovenous intervention of the saphenous system improves healing and recurrence of venous leg ulcers (Clinical-Etiology-Anatomy-Pathophysiology class 6). As ablative methods continue to evolve, it is essential to identify outcome differences between the various techniques. This study aims to compare wound healing rates between primary nonthermal ablation (cyanoacrylate glue [CAG] or commercial polidocanol microfoam ablation [MFA]) and thermal ablation with adjunct MFA.

Methods: In this multicenter retrospective cohort study, patients with healed venous ulcers after nonthermal endovenous treatment were identified from four tertiary referral US institutions. Demographics, comorbidities, procedural, and wound data were collected. Patients whose full-length great saphenous vein was treated with a single nonthermal modality (CAG or MFA) were compared with those treated with radiofrequency ablation plus MFA of the below-knee segment. Multivariate linear regression was performed to identify predictors of wound healing.

Results: We identified 55 patients (27 primary CAG or MFA and 28 radiofrequency ablation plus MFA). The average age was 70 ± 12 years, 56% were male, and 53% had a body mass index of >30 kg/m². Comorbidities were similar between the cohorts. The median ulcer size was 3 cm². The median time to wound healing was 61 days (interquartile range, 30-258 days) with no significant difference between treatment modalities (P = .37), irrespective of ulcer size category. The rate of ulcer recurrence was 16% and did not differ between the cohorts (P = .46). Multivariate linear regression identified proximal access site as the only independent predictor of prolonged wound healing (P = .03).

Conclusions: Treatment of the full-length great saphenous vein with a single nonthermal modality (CAG or MFA) or a thermal modality plus MFA below the knee have comparable times to wound healing. This finding suggests that comprehensive treatment, irrespective of modality, of the entire great saphenous vein to the ankle is the preferred approach for optimal wound healing in Clinical-Etiology-Anatomy-Pathophysiology class 6 patients.

Keywords: Nonthermal venous ablation; Thermal venous ablation; Venous leg ulcers.