Successful management of a venous ulcer with foam sclerotherapy of the great saphenous trunk and ligation of a large incompetent perforating vein in the thigh
Christos Argyriou1, George S. Georgadis1
Affiliations: 1. Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. 2. Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
In cases of chronic venous ulcers, elimination of the great saphenous vein reflux is recommended to accelerate venous healing and reduce the risk of recurrence. Yet, there is only scarce evidence supporting the need for simultaneous management of incompetent perforators.
We describe the case of a 40-year-old female presenting with a painful chronic venous ulcer complicating great saphenous vein insufficiency emerging below its confluence to a large (7 mm) mid-thigh perforator communicating directly with the femoral vein. The saphenous diameter in the tibia was 6 mm. On the contrary, the saphenous segment proximal to the perforator presented normal diameter and adequate competence. Preoperative duplex ultrasound precluded any deep vein pathology.
After ultrasound-guided mapping, open ligation of the perforator was performed, followed by foam sclerotherapy (polidocanol 3%) of the saphenous trunk through a 5F sheath 11 cm placed at the knee level. Class II elastic compression was applied immediately after the intervention and during follow-up. The 1-week follow-up revealed an occluded saphenous trunk distal to the ligated perforator with no flow and a diameter reduced from 6 mm preoperatively to 4 mm. There was successful healing of the ulcer with gradual remission of pain. In 1-year follow-up there was neither ulcer nor pain recurrence.
Management of saphenous trunk reflux combined with large perforator reflux elimination facilitates ulcer healing with sustainable results after 1 year.
