Endovenous Laser Therapy in the Treatment of Lower-limb Venous Ulcers
| Autor: | Manish Taneja, Farah Gillan Irani, Kiat Hon Lim, T. Teo, Seck Guan Tan, Mathew George Sebastien, Kiang Hiong Tay, Bien Soo Tan, Richard Lo, Shueh En Lin |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Deep vein Varicose Ulcer Laser therapy Occlusion Biopsy medicine Humans Saphenous Vein Radiology Nuclear Medicine and imaging Aged Centimeter medicine.diagnostic_test business.industry Ultrasound Great saphenous vein Middle Aged medicine.disease Thrombosis Surgery Treatment Outcome medicine.anatomical_structure Female Laser Therapy Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Vascular and Interventional Radiology. 21:657-662 |
| ISSN: | 1051-0443 |
| DOI: | 10.1016/j.jvir.2010.01.029 |
| Popis: | Purpose To assess the efficacy of endovenous laser therapy (EVLT) in the treatment of lower-limb venous ulcers secondary to venous reflux. Materials and Methods Forty-four of 139 patients referred for EVLT from January 2004 to August 2007 had nonhealing venous ulcers. Preprocedural duplex ultrasound (US) was performed to document saphenous venous reflux secondary to saphenofemoral/saphenopopliteal junction incompetence, deep venous insufficiency, and deep vein thrombosis. Follow-up intervals were within 1 week, monthly until ulcer healing, and every 6 months thereafter. Mean follow-up period was 35.8 months (range, 8.1–59.3 months). Results Mean great saphenous vein (GSV) diameter and length treated were 9.9 mm (range, 5.5–16.0 mm) and 36.7 cm (range, 20.0–60.0 cm). Mean laser energy used was 3,292 J (range, 1,392–4,971 J). Mean energy deposited per centimeter of vein was 93.6 J/cm (range, 45.2–182.0 J/cm). Mean laser time was 232 seconds (range, 99–347 sec). Fifteen patients with follow-up duplex US had no GSV flow at 6 months, with nonvisualization indicating complete obliteration. Ulcer healing occurred as early as 1 week after the procedure in some patients. Cumulative healing rates at 1, 3, 6, and 12 months were 82.1%, 92.5%, 92.5%, and 97.4%, respectively. No ulcer had recurred at 1 year, but ulcers recurred in five patients at 14, 14, 23, 35, and 52 months after EVLT, respectively. One patient with a nonhealing ulcer 2 years after treatment developed well differentiated squamous cell carcinoma. Conclusions Ulcer epithelization occurred with continued GSV occlusion and loss of flow. Most ulcers healed within 3 months with no recurrence at 1 year. Nonhealing ulcers should undergo biopsy to exclude malignant transformation. |
| Databáze: | OpenAIRE |
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