دورية أكاديمية
Impact of great saphenous vein ablation on healing and recurrence of venous leg ulcers in patients with post-thrombotic syndrome: A retrospective comparative study.
| العنوان: | Impact of great saphenous vein ablation on healing and recurrence of venous leg ulcers in patients with post-thrombotic syndrome: A retrospective comparative study. |
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| المؤلفون: | Bishara RA; Vein Clinics Egypt, Cairo, Egypt. Electronic address: rashadbishara@gmail.com., Gaweesh A; Vascular Surgery Department, Alexandria University, Alexandria, Egypt., Taha W; Vein Clinics Egypt, Cairo, Egypt., Tolba MM; Pharmaceutical Division, Ministry of Health, Cairo, Egypt., Shalhoub J; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College, London, UK. |
| المصدر: | Journal of vascular surgery. Venous and lymphatic disorders [J Vasc Surg Venous Lymphat Disord] 2024 May; Vol. 12 (3), pp. 101859. Date of Electronic Publication: 2024 Mar 04. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101607771 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2213-3348 (Electronic) NLM ISO Abbreviation: J Vasc Surg Venous Lymphat Disord Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Elsevier Inc., c2013- |
| مواضيع طبية MeSH: | Varicose Ulcer*/therapy , Postthrombotic Syndrome* , Venous Insufficiency*/surgery, Humans ; Ulcer ; Retrospective Studies ; Saphenous Vein/surgery ; Treatment Outcome ; Recurrence |
| مستخلص: | Background: The optimal treatment approach for patients with active venous leg ulcers (VLUs) and post-thrombotic syndrome (PTS) associated with great saphenous vein (GSV) reflux remains unclear. To address this gap, we retrospectively compared the outcomes of patients with post-thrombotic VLU with an intact GSV vs those with a stripped or ablated GSV. Methods: We retrospectively analyzed data from 48 patients with active VLUs and documented PTS, who were treated at a single center between January 2018 and December 2022. Clinical information, including ulcer photographs, was recorded in a prospectively maintained digital database at the initial and follow-up visits. Two patient groups-group A (with an intact GSV) and group B (with a stripped or ablated GSV)-were compared in terms of time to complete healing, proportion of ulcers achieving complete healing, and ulcer recurrence during the follow-up period. Results: There were no significant differences in age, gender, initial ulcer size, or ulcer duration between the two groups. All included patients had femoropopliteal post-thrombotic changes. Group A had significantly more completely healed ulcers (33 of 34 ulcers, 97%) compared with group B (10 of 14 ulcers, 71%) (P = .008). Group A also exhibited a significantly shorter time to complete ulcer healing (median: 42.5 days, interquartile range [IQR]: 65) compared with group B (median: 161 days, IQR: 530.5) (P = .0177), with a greater probability of ulcer healing (P = .0084). Long-term follow-up data were available for 45 of 48 patients (93.7%), with a mean duration of 39.6 months (range: 5.7-67.4 months). The proportion of ulcers that failed to heal or recurred during the follow-up period was significantly lower in group A (9 of 32 ulcers, 27%) compared with group B (11 of 13 ulcers, 85%) (P = .0009). In addition, in a subgroup analysis, patients with an intact but refluxing GSV (12 of 34) had a significantly shorter time to heal (median: 34 days, IQR: 57.25) (P = .0242), with a greater probability of ulcer healing (P = .0091) and significantly fewer recurrences (2 of 12, 16%) (P = .006) compared with group B. Conclusions: Our findings suggest that removal of the GSV through stripping or ablation in patients with post-thrombotic deep venous systems affecting the femoropopliteal segment may result in delayed ulcer healing and increased ulcer recurrence. Patients with an intact GSV had better outcomes, even when the refluxing GSV was left untreated. These findings emphasize the potential impact of GSV treatment on the management of VLUs in individuals with PTS. Further investigation is needed to validate these results and explore alternative therapeutic strategies to optimize outcomes for this patient population. Competing Interests: Disclosures None. (Copyright © 2024. Published by Elsevier Inc.) |
| فهرسة مساهمة: | Keywords: Great saphenous vein; Great saphenous vein ablation; Post-thrombotic syndrome; Ulcer; Venous leg ulcer |
| تواريخ الأحداث: | Date Created: 20240306 Date Completed: 20240419 Latest Revision: 20240419 |
| رمز التحديث: | 20240419 |
| DOI: | 10.1016/j.jvsv.2024.101859 |
| PMID: | 38447878 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2213-3348 |
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| DOI: | 10.1016/j.jvsv.2024.101859 |