Promising results of ultrasound guided foam sclerotherapy for treating chronic venous ulcers

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE Journal of vascular surgery. Venous and lymphatic disorders Pub Date : 2025-05-01 Epub Date: 2025-01-29 DOI:10.1016/j.jvsv.2025.102198

Ana Clarice de Carvalho Bacelar MD , Eduardo M. Netto MD, MPH, PhD , Natália Barreto MD , Rodrigo Neves MD , Cláudia Heine MD , Pedro Botelho MD , Clarissa S. Almeida MD , Eduardo Ramalho MD , Roque Aras MD, PhD

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Abstract

Background

Despite advances in wound care, the dressing and management of chronic ulcers on lower limbs remains unsatisfactory. The simplicity, cost effectiveness, and diverse application possibilities of ultrasound-guided foam sclerotherapy make it an attractive and effective approach to treat patients with no access to or contraindications to more invasive methods. We sought to evaluate the healing rate of chronic venous ulcers (Clinical, Etiological, Anatomical, Pathophysiological [CEAP] C6) in patients treated with ultrasound guided foam sclerotherapy.

Methods

From January 2018 to December 2020, 279 patients (336 legs) classified at the first consultation as stage 6 for CEAP disease were followed during treatment of axial venous reflux in saphenous and tributary veins with polidocanol (Aethosxysklerol) foam and evaluated at 52 weeks for complete healing rates or ≥50% ulcer size reduction, using Kaplan-Meier statistics and Cox regression to study the influence of covariates.

Results

The average age of the 279 patients was 55 years. Of these, 156 (56%) showed complete healing in 52 weeks and 89 (32%) achieved a wound area reduction of >50%. Ulcer size, severity, lymphedema, and reduced dorsiflexion of the ankle were significantly associated with healing difficulty. Time of ulcer progression up to beginning of treatment (P < .01), ulcer size (P = .01), lymphedema (P = .006), reduced dorsiflexion of the ankle (P = .01), and age ≥65 years (P = .003) were significantly associated with difficulty in healing. Patients with a mean Venous Clinical Severity Score of 18.7 had a better prognosis (18.7 vs 22.5; P < .001).

Conclusions

Most patients with chronic venous ulcers (CEAP 6) treated with foam sclerotherapy achieved healing or significant improvement within 52 weeks. Healing was highly influenced by time until treatment, ulcer size, reduced dorsiflexion of the ankle and/or lymphedema presence, and the use of compression therapy.

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超声引导泡沫硬化疗法治疗慢性静脉溃疡的前景看好。

背景：尽管伤口护理取得了进步，但下肢慢性溃疡的敷料和处理仍然令人不满意。超声引导泡沫硬化治疗的简单性、成本效益和多种应用可能性使其成为一种有吸引力和有效的治疗方法，用于治疗那些没有更有侵入性方法或有禁忌的患者。目的：评价超声引导泡沫硬化治疗慢性静脉溃疡（ceapc6）的疗效。方法：2018年1月至2020年12月，279例（336条腿）首次会诊时被划分为CEAP 6期（临床、病因、解剖、病理生理分类）的患者在使用聚多卡因醇（AethosxysklerolR）泡沫治疗隐静脉和支静脉轴静脉反流期间进行随访，并在52周时评估完全愈合率或溃疡大小缩小≥50%，使用Kaplan-Meier统计和Cox回归研究协变量的影响。结果：279例患者平均年龄55岁。其中156例（56%）在52周内完全愈合，89例（32%）伤口面积缩小50%以上。溃疡大小、严重程度、淋巴水肿和踝关节背屈减少与愈合困难显著相关。溃疡进展至治疗开始的时间（p < 0.01）、溃疡大小（p = 0.01）、淋巴水肿（p = 0.006）、踝关节背屈减轻（p = 0.01）和年龄≥65岁（p = 0.003）与愈合困难显著相关。静脉临床严重程度评分（VCSS）平均为18.7的患者预后较好(18.7 vs 22.5；结论：大多数慢性静脉溃疡（ceap6）患者经泡沫硬化治疗后在52周内治愈或显著改善。治疗时间、溃疡大小、踝关节背屈减轻和/或淋巴水肿以及使用压迫疗法对愈合有很大影响。

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来源期刊

Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE

CiteScore

6.30

自引率

18.80%

发文量

328

审稿时长

71 days

期刊介绍： Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.