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Leg Ulcers Healed With Endovenous Laser Technique: Presented at SIR

By Ed Susman

WASHINGTON, DC -- March 24, 2008 -- An endovascular, image-guided laser treatment appears to rapidly heal leg ulcers that occur secondary to saphenous venous reflux, according to research presented here at the Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting.

"The role of endovenous laser treatment of lower-limb ulcers had not been previously evaluated," said Terence Teo, MBBS, Diagnostic and Interventional Radiologist, Singapore General Hospital, Singapore. "This study shows that endovenous laser treatment is a safe and efficacious alternative to surgical venous stripping and/or 4-layer bandaging for the treatment of lower-limb venous ulcers."

Dr. Teo and colleagues enrolled 21 men and 23 women presenting with nonhealing venous ulcers between January 2004 and August 2007. They were evaluated in a nonrandomised, consecutive enrolment study. Nine of the patients had previous varicose vein surgery. All but 1 patient had great saphenous venous reflux; this 1 patient had short saphenous vein reflux. The cohort's mean age was 62.9 years.

Under ultrasound guidance, doctors punctured the great saphenous vein near the knee to allow insertion of a 5French sheath. A 600-micron laser fibre was advanced through the vein and the tip was positioned within 1 to 2 cm from the junction of either the saphenous-femoral junction or the saphenous-popliteal junction. Lidocaine 0.2% was injected as an anaesthetic along the vein as the laser was activated. The laser was fired at 14 W. After the procedure, a pressure bandage was applied from the groin to the ankle.

Patient follow-up was performed at 1 week, 1 month, 3 months, 6 months, and 12 months.

A 4-layer bandage was not applied to the ulcer, Dr. Teo said during his poster presentation on March 19.

Dr. Teo said that the diameter of the lased vein ranged from 5.5 to 15 mm and the length ranged from 20 to 60 cm. The mean energy deposited per centimetre of vein was about 93.6 J.

The rate of healing after 1 month was 82%; at 3 months, 89.7% of patients had healed ulcers; at 12 months, 94.9% of patients had healed ulcers, Dr. Teo said.

During the 1-year follow-up, there were no reports of current ulcers. Five patients were lost to follow-up.


[Presentation title: Endovenous Laser Treatment (EVLT) in the Treatment of Lower Limb Venous Ulcers. Abstract 293]

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