Compliance with compression therapy in primary chronic venous disease: Results from a tropical country

Investigating low rates of compliance to graduated compression therapy for chronic venous insufficiency: A systematic review

Chronic venous insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold-standard treatment, but its underutilisation, as indicated in recent literature, may be contributing to the growing burden of CVI. The aim of this systematic review is to determine the reasons for poor compliance in patients who are prescribed graduated compression therapy in the management of chronic venous insufficiency. A systematic review of the literature was conducted to identify the reasons for non-compliance in wearing graduated compression therapy in the management of chronic venous insufficiency. The keyword search was conducted through Medline, PubMed, CINAHL, Cochrane library, AMED, and Embase databases from 2000 to April 2023. Qualitative and quantitative studies were included with no study design or language limits imposed on the search. The study populations were restricted to adults aged over 18 years, diagnosed with chronic venous insufficiency. Of the 856 studies found, 80 full-text articles were reviewed, with 14 being eligible for the review. Due to the variability in study designs, the results were summarised rather than subjected to meta-analysis. There are five main overarching themes for non-compliance, which are physical limitations, health literacy, discomfort, financial issues, and psychosocial issues with emerging sub-themes. Graduated compression therapy has the potential to reduce the burden of chronic venous insufficiency if patients are more compliant with their prescription.

Durometry for the Assessment of Severity of Post-thrombotic Syndrome and Possible Clinical Applications

BACKGROUND

Post-thrombotic syndrome (PTS) impacts the patient's quality of life. Available scales to determine its severity remain controversial, therefore, it is of importance to identify new auxiliary methods for the assessment of this sequelae. Measurement of skin hardness (MSH) might be decisive in tracking PTS. The purpose of this study is to assess if the use of durometry is an objective measure to evaluate prognosis of affected limbs in patients with PTS. We compared MSH of extremities with PTS vs healthy limbs, as well as their variation after 3 months of medical treatment to evaluate if durometry can be used to find differences. We strongly believe that measuring and keeping track of skin changes specifically skin hardness can be a useful factor in the prognosis and treatment of PTS.

METHODS

Prospective cohort study from January 2021 to February 2022 in patients with unilateral PTS. The MSH of the affected limb was compared to the healthy limb. A calibrated durometer was used, 4 measurements were completed at the time of diagnosis and subsequent follow-up were carried out after 3 months of treatment. The percentage of healing (in case of ulcers) and adherence to treatment was carefully monitored. The statistical program R was used.

RESULTS

A total of 1088 durometric measurements were performed on 17 patients, and 34 limbs. The MSH in limbs with PTS was 39.09 and in the control limbs (19.8) (P = <.00001). After 3 months of treatment, the MSH in PTS varied in PTS limbs (39.09 to 30.4) (P = <.000012). Adherence to treatment was 70.5%.

CONCLUSIONS

MSH varied between healthy limbs and the ones with PTS, before and after treatment. Durometry might represent a method for assessing skin changes in patients with PTS.

The role of compression therapy after endovenous laser ablation (EVLA) - review

<b><br>Introduction:</b> Chronic venous disease (CVD) is a rising problem in western countries. There are several stages of CVD that can be treated with different ways. One of the methods of treating varicosity, C2 stage of CVD, is still developing endovenous laser ablation (EVLA). This method is popular due to its short operation time, less bleeding, quick recovery and no surgical scars. The compression therapy in form of compression stockings has been widely used as a conservative treatment of early stage CVD and it's also used after EVLA. However there are no strong recommendations towards using compression therapy after this kind of surgery.</br> <b><br>Aim and Method:</b> This paper is aimed to review existing knowledge about compression therapy benefits and its recommended time period after EVLA. Search engines used in review: Pubmed and Cochrane.</br> <b><br>Results:</b> Studies focusing on the compression therapy after EVLA of varicose veins have questioned the prolonged use of compression therapy as it brings no additional benefits and might be difficult for patients to adhere. The existing studies recommended the time period no greater than 1-2 weeks. There are no significant changes in reoccurrence rate and return to normal activities between compression and non-compression group. It is proven that compression therapy significantly reduces the postoperative pain and consumption of analgesics.</br> <b><br>Discussion:</b> Compression therapy seems as a safe option for low pain management. There is a need for further research involving the impact of the compression therapy after EVLA, especially in group of low energy delivered settings as the results of treatment are promising.</br>.

Treatments for symptomatic class I patients in CEAP classification with saphenous vein reflux: A pilot study

BACKGROUND

For patients with telangiectasia or reticular veins (CEAP [clinical, etiologic, anatomic, pathophysiologic] class C1), less invasive endovenous (EV) treatments have emerged. However, no prospective studies have compared compression stockings (CSs) and EV ablation treatment for C1 symptomatic refluxing saphenous veins. The present prospective study compared the therapeutic results of the two treatment modalities.

METHODS

From June 2020 to December 2021, 46 patients with telangiectasia or reticular veins (<3 mm; class C1) with axial saphenous reflux and venous congestion symptoms were prospectively enrolled. The patients were assigned to CS (n = 21) or EV treatment (n = 25), according to patient preference. Complications, clinical improvement scales (eg, the venous clinical severity score [VCSS]), and quality of life, including the Aberdeen varicose vein symptom severity score (AVSS) and venous insufficiency epidemiological and economic study - quality of life/symptoms (VEINES-QOL/Sym), were evaluated and compared between the two groups at 1, 3, and 6 months after treatment.

RESULTS

No major complications occurred in either group. The median VCSS was 2.0 (interquartile range [IQR], 1.0-2.0), 1.0 (IQR, 0.5-2.0), 1.0 (IQR 0.0-1.0), and 0.0 (IQR 0.0-1.0) at baseline and 1, 3, and 6 months after treatment in the CS group, respectively. The corresponding VCSSs were 3.0 (IQR, 1.0-3.0), 1.0 (IQR, 0.0-1.0), 0.0 (IQR, 0.0-0.0), and 0.0 (IQR, 0.0-0.0) in the EV group. The median AVSS was 4.4 (IQR, 3.0-5.5), 2.1 (IQR, 1.3-4.6), 1.0 (IQR, 0.0-2.8), and 0.0 (IQR, 0.0-1.8) at baseline and 1, 3, and 6 months after treatment in the CS group, respectively. The corresponding scores were 6.2 (IQR, 3.8-12.3), 1.6 (IQR, 0.6-2.8), 0.0 (IQR, 0.0-2.6), and 0.0 (IQR, 0.0-0.4) in the EV group. The mean VEINES-QOL/Sym score was 92.7 ± 8.1, 100.4 ± 7.3, 104.3 ± 8.2, and 106.0 ± 9.7 in the CS group at baseline and 1, 3, and 6 months after treatment, respectively. The corresponding scores were 83.6 ± 8.0, 102.9 ± 6.6, 107.9 ± 3.9, and 109.6 ± 3.7 in the EV group. Both groups showed considerable improvement in the VCSS, AVSS, and VEIN-SYM/QOL scores, and no significant between-group differences were observed for ≤6 months. Among the severely symptomatic patients (pretreatment VEINES-QOL/Sym score ≤90), the EV group exhibited more marked improvement (P = .029 for the VCSS and P = .030 for the VEINES-QOL/Sym score).

CONCLUSIONS

Both CSs and EV treatment provided clinical and quality of life improvement in symptomatic C1 patients with refluxing saphenous veins, with no significant between-group differences. However, a subgroup analysis revealed that EV treatment provided statistically significant improvement in the severe symptomatic C1 group.

Conservative therapy significantly reduces patients' chronic venous disease symptoms: A Caribbean insight into the VEIN Act Program

OBJECTIVES

We sought to determine the baseline demographic and clinical characteristics of patients with Chronic Venous Disease (CVD) across the Caribbean, and to evaluate patients' compliance to conservative therapy and the effectiveness of such therapy in reducing patients' CVD symptoms.

METHOD

Patients were enrolled into the VEIN Act Program, and their demographic data, CVD symptoms (and their intensity) and CEAP C-classification was recorded at the first visit. Patients were prescribed conservative therapy, and symptom intensity and patient compliance and satisfaction evaluated at a follow-up visit.

RESULTS

We enrolled 193 patients into the study, most of which (76%) were female, between 39-78 years (80%) and within the C₂-C_4a classes (56.1%). Pain (61.1%) and heaviness (58.5%) were the most common symptoms. Patient compliance to the prescribed treatment was relatively high for all modalities (>75%) and most patients (92.1%) were at least somewhat satisfied with their treatment.

CONCLUSIONS

Patient compliance to conservative therapy for management of CVD is high across the Caribbean, and such therapy is effective in reducing intensity of CVD symptoms.

Compression stocking compliance does not impact reintervention or symptom change after iliac vein stenting in patients with moderate to severe lower extremity edema

BACKGROUND

Medical compression stocking (MCS) therapy remains a core treatment for chronic venous disease, particularly in patients with lower extremity edema. This study investigated the impact of postoperative MCS adherence in patients with moderate to severe edema who underwent iliac vein stenting.

METHODS

Patients at a large tertiary care center who underwent iliac vein stenting from August 2011 to June 2021 were analyzed. Symptoms were quantified using the venous clinical severity score (VCSS) and clinical assessment score (CAS). The criterium for inclusion was moderate or severe lower extremity edema at the time of iliac vein stenting. Patients were stratified into two cohorts: complete postoperative compression therapy compliance (MCS+) and no postoperative compression therapy use (MCS-).

RESULTS

Among 376 patients fitting our study criteria, we identified 168 MCS+ and 208 MCS- patients. Preoperatively, the VCSS composite score was higher for the MCS+ group (11.7 vs. 9.5, p < 0.001), but the VCSS edema score did not significantly differ between groups (p = 0.179). Postoperatively, the mean changes in VCSS edema at the first postoperative visit, the one-year follow-up, and the two-year follow-up were not significantly different between the MCS+ and MCS- cohorts (p = 0.123, 0.296, 0.534, respectively). Analysis of CAS for edema revealed that the MCS+ cohort had modestly better improvement in edema at the 90-day follow-up visit vs. the MCS- cohort (p = 0.018), but this difference was not observed in the 30-day (p = 0.834) or 6-month follow up visit (p = 0.755). Multivariate analysis revealed no difference in the need for major intervention (OR 0.93 [95% CI 0.44 - 1.50], p = 0.504). Kaplan Meier analysis via log-rank test revealed no difference in reintervention-free survival between groups (p = 0.77).

CONCLUSION

Many patients with moderate to severe lower extremity edema experience reduction in their edema after iliac vein stenting. In our study, compression stocking compliance after surgery had little impact on edema relief in this population.

Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy

OBJECTIVE

This study aimed to compare the healing outcomes between three types of compression therapy-two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing.

METHOD

A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables.

RESULTS

Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001).

CONCLUSION

In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.

Management of chronic venous disease in general practice: a cross-sectional study of first line care in Belgium

BACKGROUND

The aim of this observational study is to examine how general practitioners (GP) in Belgium treat patients with Chronic Venous Disease (CVD).

METHODS

This cross-sectional study was carried out in Belgium by GPs who recruited 15 consecutive patients who were consulting them and suffered from CVD. By following a standardized questionnaire, they collected information on patient characteristics, risk factors, signs and symptoms, and how they were being managed.

RESULTS

253 GPs recruited 3055 patients, who were predominantly female (75.6%), with a mean age of 62.7 (SD 14.6). 20.1% of the population suffered from CVD without clinical signs (C0s). 8.7% of the population had advanced disease (C5-C6). Most common symptoms were respectively 'heavy legs' (43,7%), 'swollen feeling' (28%) and 'pain' (24,1%). The primary care physicians decided 95.3% of patients needed therapy of some sort. The most used treatment option used in 83.3% of subjects was the use of venoactive medication. Lifestyle advice was recommended in 64.5% of patients and recommendations regarding compression stockings was given in 46.9% of patients. Referral to a specialist was warranted for 24.5% of the population. Patients with a lower C-classification were more often treated conservatively compared to those with a higher C-classification.

CONCLUSIONS

Most patients were treated conservatively, which includes lifestyle changes, medication, and compression. Only one in four patients is referred to a vascular specialist and this referral is significantly positively correlated with the C-classification.

Compression Therapy Following Endovenous Thermal Ablation of Varicose Veins: A Systematic Review and Meta-Analysis

OBJECTIVE

A systematic review and meta-analysis were performed to evaluate the necessity for compression therapy with elastic stockings following endovenous thermal ablation (EVTA) for chronic venous insufficiency.

METHODS

MedLine, ScienceDirect and the Cochrane Library were searched for the relevant literature according to the inclusion and exclusion criteria. Two researchers independently extracted data and assessed the quality of the literature. Randomized controlled trials comparing the use of elastic stockings for compression therapy versus no compression therapy following RFA or EVLA for varicose veins were included in this study. The primary outcome of postoperative pain was assessed using the visual analogue pain scale. Secondary outcomes included the bruising score, quality of life, venous clinical severity score, time to return to normal activities, complications, and the rate of saphenous vein occlusion. The mixed effect model or random effect model was used to calculate relative risk (RR), mean difference (MD) or standardized mean difference following the heterogeneity test. Sensitivity analysis was performed for outcomes with high heterogeneity (I² >50%). Outcomes were described qualitatively for studies that could not be pooled.

RESULTS

Six RCTs with 1,045 subjects were included. Overall, postoperative compression therapy significantly reduced the mean pain in the first 10 days post-EVTA (MD = - 4.98,95% CI: -8.71 to -1.24), and the time to return to normal activities (MD = -1.01, 95% CI: -1.97 to -0.06). In terms of the bruising score, the venous clinical severity score, complications (RR = 1.05,95% CI: 0.55-2.00), quality of life at 2 weeks (MD = -0.71,95% CI: -2.09 to 0.67) and 6 months (MD = 0.26,95% CI: -1.22 to 1.74), and the saphenous vein occlusion rate (RR=1.00,95% CI: 0.95-1.04), there were no significant differences between the compression and control groups.

CONCLUSION

Our study recommends the routine use of compression therapy with elastic stockings following EVTA of varicose veins to reduce postoperative pain and the time to return to normal activities. However, further multi-center and high-quality randomized clinical trials are needed for the unified treatment for varicose veins, the target population as well as the duration of compression therapy on whether elastic stockings is beneficial following EVTA.

A randomized trial of class II compression sleeves for full legs versus stockings after thermal ablation with phlebectomy

OBJECTIVE

Compression stockings and bandages are widely used after invasive treatment of varicose veins. The goals of compression after venous interventions are to reduce pain, bruising, and ecchymosis. Nevertheless, patients often report discomfort with the compression. To make postprocedural compression more tolerable, foot-sparing bandages were tested in a randomized clinical trial of noninferiority.

METHODS

A total of 187 patients were randomized to use class II foot-sparing compression sleeves for the full leg or class II stockings after radiofrequency ablation with concomitant phlebectomy. The primary endpoint was the quality of life, measured using the Chronic Venous Disease Quality of Life Questionnaire 20-item scale 30 days after intervention. The secondary endpoints were pain in the leg and discomfort related to the compression garment, which were assessed using the visual analog scale (VAS) at 2, 7, 14, and 30 days.

RESULTS

The global index score of the questionnaire was 66.1 and 70.6 and 83.8 and 87.7 for the sleeve and stocking groups before and 30 days after intervention, respectively (P = .542 and P = .150, respectively). The VAS for pain score in the operated leg was slightly higher in the sleeve group the day after the intervention (score, 2.1 vs 1.6; P = .03). At 7, 14, and 30 days, the VAS for pain scores did not differ significantly (score, 0.7 vs 0.5; 0.5 vs 0.3; and 0.1 vs 0.1, respectively; P = NS for all). The VAS for discomfort score was not significantly different statistically in the study group at 2 days (sleeve, 1.9; vs stocking, 1.4; P = .08) but was higher after 7 days (sleeve, 0.9; vs stocking, 0.6; P = .008). No difference in discomfort was found between the study and control groups at 14 or 30 days (sleeve, 0.6; vs stocking, 0.4; and sleeve, 0.4; vs stocking, 0.4, respectively; P = NS for both).

CONCLUSIONS

Quality of life after thermal ablation with phlebectomy improved equivalently in patients who had used class II compression sleeves for full legs and those who had used class II compression stockings. Pain and discomfort were slightly higher in the sleeve group.

Improving Adherence to Wearing Compression Stockings for Chronic Venous Insufficiency and Venous Leg Ulcers: A Scoping Review

PURPOSE

Patient adherence to wearing compression stockings in the management of chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) is low. Poor adherence with compression stockings contributes to recurrence and impaired healing of VLUs. As such, the purpose of this review was to report on the scientific evidence related to adherence and explore modifiable factors which impact adherence with compression stockings.

METHODS

A systematic search was conducted from inception to 31 October 2019. Following the PRISMA-ScR Checklist, PubMed, Medline, CINAHL, Cochrane, Embase, OT Seeker and Web of Science were explored using search terms: compression/compression stocking/compression garment/compression sock/stockings/garments and adherence/compliance/concordance.

RESULTS

We identified 2613 papers of which 125 full text papers were assessed for eligibility and 69 met inclusion criteria. Papers were grouped and charted by concepts relevant to the research questions and narratively synthesized. Several dominant themes emerged, and a conceptual framework was developed incorporating modifiable variables, adherence itself, and outcomes related to adherence. Specifically considering interventions to improve adherence, only five of 14 randomized controlled trials were able to demonstrate improvements in adherence through unidimensional approaches. All nine of the case studies/series demonstrated a positive impact on adherence, eight of which described a personalized multidimensional approach. A lack of consensus around defining, measuring, and quantifying adherence with compression stockings was identified, resulting in wide variation in reported adherence rates.

CONCLUSION

Inconsistency in the definition and measurement of adherence limits meaningful interpretation of the literature. No individual intervention has consistently demonstrated improved adherence. Multidimensional interventions show promise but require further investigation with high-quality trials. Improving adherence appears to improve health outcomes in VLU /CVI populations but there is a lack of information directly linking improved adherence with cost outcomes.

TRIAL REGISTRATION

Open Science Framework: ACTRN12620000544976p.

Compression Stocking With 100% Donning and Doffing Success: An Open Label Randomised Controlled Trial

OBJECTIVE

The aim of this study was to test whether an investigational two layer stocking exerting 27-29 mmHg pressure at the medial supramalleolar level, but without compression in the foot and heel, is easier to put on and take off than a standard stocking of the same compression class (23-32 mmHg), and also to assess the prevention of diurnal oedema with both types of stocking.

METHODS

This was an open label randomised controlled trial, which included 47 patients. All participants were at least 65 years of age and suffered from chronic venous disease class C3 - C6 in one leg. The primary end point was donning success; secondary endpoints were doffing success, prevention of diurnal oedema over one day, and the comfort of wearing the stocking. Patients were randomly allocated to one of two groups. Both types of compression stocking were compared in each group for ease of donning and doffing in the manner of a crossover study. Subsequently, patients wore the stocking type assigned to their group for a whole day to evaluate comfort and the effect on diurnal leg volume.

RESULTS

All participants were able to don the investigational stocking unaided, compared with 75% for the standard stocking (p < .001). Unaided removal success was 100% with the investigational stocking vs. 66% for the standard stocking (p < .001). There was no significant difference in leg volume reduction between the study groups after a day of wear. The investigational stocking was also rated as being more comfortable than the standard stocking (p < .001).

CONCLUSION

The investigational stocking, which has no compression in the foot or heel area, is significantly easier to don and doff, with no inferiority in oedema prevention, compared with a standard stocking of the same compression class.

Open-label, randomised, multicentre crossover trial assessing two-layer compression bandaging for chronic venous insufficiency: results of the APRICOT trial

Compression bandaging is the mainstay therapy for chronic venous insufficiency and venous leg ulcers, but patient compliance can be challenging due to associated discomfort. The study discussed here aimed to compare AndoFlex TLC Calamine and Coban2 compression bandaging in relation to patient comfort and pruritus symptomology, with severity of pruritus as the primary outcome. This was a multi-centre, prospective, non-blinded, randomised controlled crossover trial involving 39 randomised patients with chronic venous insufficiency patients. In two periods, the patients wore AndoFlex TLC Calamine or Coban2 for 3 weeks each. No significant differences in validated pruritus outcome measures were observed, including a non-significant treatment effect for the severity of pruritus scale (n=35 trial completers; p-value=0.24, Wilcoxon test). However, after trying both bandages, 21 of the 35 patients (60%) definitely preferred AndoFlex TLC Calamine, whereas 4 patients (11%) definitely preferred Coban2. Thus, AndoFlex TLC Calamine compression bandage therapy was preferred by most patients, although this observation could not be confirmed using validated patient-reported outcome measures for pruritus. Further research is indicated to establish if patient preference translates into favourable clinical outcomes. ISRCTN number: ISRCTN95282887.

Sulodexide for the Symptoms and Signs of Chronic Venous Disease: A Systematic Review and Meta-analysis

INTRODUCTION

Chronic venous disease (CVD) is a common condition associated with valvular dysfunction, venous hypertension and endothelial inflammation. Sulodexide facilitates the healing of venous ulcers and is frequently used in patients with CVD without ulcer. This review assessed the efficacy and safety of sulodexide for treatment of signs and symptoms of lower extremity CVD.

METHODS

We searched MEDLINE, EMBASE, CINAHL and AMED as well as the Cochrane Central Register of Controlled Trials and the World Health Organisation (WHO) International Clinical Trials Registry Platform Search Portal. We also manually searched potentially relevant journals, conference proceedings and journal supplements. Any study monitoring any effect of sulodexide in patients with CVD at any stage of the disease, classified or non-classified, was considered. Treatment effects were estimated using standardised mean differences (SMDs), mean differences (MDs) and risk ratios (RRs), as appropriate. We calculated 95% confidence intervals (CIs) and heterogeneity (Q, tau and I²).

RESULTS

The search found 64 studies, but only 23 provided data on 7153 participants (mean age 55 years; 68% female). The 13 studies providing extractable quantitative information included 1901 participants (mean age 55.2 years; 65% female). Sulodexide decreased the intensity of pain, cramps, heaviness, oedema and total symptom score and reduced inflammatory mediators in patients with CVD. The risk of adverse events (AEs) was not different between sulodexide and placebo or heparan sulphate (RR 1.31, 95% CI 0.74-2.32; I² = 0%; 270 participants). The overall risk of AEs with sulodexide was low: 3% (95% CI 1-4%) estimated from 3656 participants.

CONCLUSION

Sulodexide was found to have a beneficial venoactive effect on the major signs and symptoms of CVD such as pain, cramps, heaviness and oedema without increasing the risk of AEs. It is also likely to exert a systemic effect on the course of CVD by interfering with inflammatory chemokines.

Factors that influence venous leg ulcer healing and recurrence rate after endovenous radiofrequency ablation of incompetent saphenous vein

OBJECTIVE

Endovenous radiofrequency ablation (RFA) is one of the most popular techniques for correcting superficial vein reflux. However, the effectiveness of RFA of superficial vein reflux in patients with active or healed venous leg ulcer (VLU) is unknown. Accordingly, the objective of this study was to evaluate the healing rate, the recurrence rate, and the factors significantly associated with healing and recurrence in patients with active or healed VLU who had superficial venous reflux treated with RFA.

METHODS

We retrospectively reviewed all healed VLU or active VLU patients treated with RFA at the Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, during January 2011 to December 2017 to evaluate the rate of VLU healing and recurrence. Time to healing and time to ulcer recurrence were determined by Kaplan-Meier survival analysis. Risk factors were assessed to determine their association with VLU healing and recurrence by Cox regression survival analysis.

RESULTS

RFA of the great saphenous vein (n = 56), anterior accessory saphenous vein (n = 5), or both (n = 1) was performed on 62 limbs with active (n = 32) or healed (n = 30) VLUs. The mean age of patients was 65.4 ± 9.8 years, and 80% were female. Deep venous insufficiency was present in 10 limbs (16%). Pathologic perforating vein was found in 17 patients (27%). Concomitant ultrasound-guided foam sclerotherapy (UGFS) of the pathologic perforating vein was performed in 12 limbs (19%). Concomitant phlebectomy was performed in 19 limbs (31%). The median follow-up time was 753 days after RFA. VLU healed in 31% of patients at 3 months, in 56% at 6 months, and in 66% at 1 year after RFA. Concomitant UGFS of the pathologic perforating vein was the only factor significantly associated with VLU healing (hazard ratio, 2.84; 95% confidence interval, 1.07-7.55; P = .037). VLU recurrence was found in 8% of patients at 1 year, in 14% at 2 years, and in 23% at 3 years after RFA. Deep vein reflux was the only identified risk factor for VLU recurrence (hazard ratio, 3.72; 95% confidence interval, 1.05-13.21; P = .042).

CONCLUSIONS

UGFS of the pathologic perforating vein at the time of RFA of saphenous vein reflux improved VLU healing. VLU recurrence was more frequent in patients with concomitant deep vein reflux. The authors suggest performing UGFS of the pathologic perforating vein at the time of RFA to improve VLU healing and monitoring of patients with associated deep vein reflux for ulcer recurrence.