Comparison of therapeutic effects of ligation and stripping of great saphenous vein combined with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZENG Yanzhang , YANG Yi ,  ZHAO Jichun

Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

ZHAO Jichun, Email: zhaojc3@163.com

Keywords：

ligation and stripping of great saphenous vein; foam sclerotherapy; venous leg ulcer

DOI：

10.7507/1007-9424.201709081

Video：

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Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.

Citation： ZENG Yanzhang, YANG Yi, ZHAO Jichun. Comparison of therapeutic effects of ligation and stripping of great saphenous vein combined with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(3): 312-316. doi: 10.7507/1007-9424.201709081 Copy

1.	McLafferty RB, Passman MA, Caprini JA, et al. Increasing awareness about venous disease: The American Venous Forum expands the National Venous Screening Program. J Vasc Surg, 2008, 48(2): 394-399.
2.	Ghauri AS, Taylor MC, Deacon JE, et al. Influence of a specialized leg ulcer service on management and outcome. Br J Surg, 2000, 87(8): 1048-1056.
3.	Bergqvist D, Lindholm C, Nelzén O. Chronic leg ulcers: the impact of venous disease. J Vasc Surg, 1999, 29(4): 752-755.
4.	Rice JB, Desai U, Cummings AK, et al. Burden of venous leg ulcers in the United States. J Med Econ, 2014, 17(5): 347-356.
5.	Purwins S, Herberger K, Debus ES, et al. Cost-of-illness of chronic leg ulcers in Germany. Int Wound J, 2010, 7(2): 97-102.
6.	Rabe E, Pannier F. Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology, 2010, 25 Suppl 1: 64-67.
7.	O’Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev, 2012, 11: CD000265.
8.	Bello YM, Phillips TJ. Therapeutic dressings. Adv Dermatol, 2000, 16: 253-271.
9.	高薦轅, 金輝. 下肢靜脈性潰瘍診治進展. 中國實用外科雜志, 2015, 35(12): 1355-1358.
10.	Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg, 2001, 27(1): 58-60.
11.	美國靜脈論壇CEAP分級國際特別委員會. 共識報告——慢性靜脈病變CEAP分級法的修訂. 中華外科雜志, 2006. 44(1): 59-61.
12.	Alguire PC, Mathes BM. Chronic venous insufficiency and venous ulceration. J Gen Intern Med, 1997, 12(6): 374-383.
13.	Etufugh CN, Phillips TJ. Venous ulcers. Clin Dermatol, 2007, 25(1): 121-130.
14.	Partsch H, Flour M, Smith PC, et al. Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. Int Angiol, 2008, 27(3): 193-219.
15.	Coleridge-Smith PD. Leg ulcer treatment. J Vasc Surg, 2009, 49(3): 804-808.
16.	Kheirelseid EA, Bashar K, Aherne T, et al. Evidence for varicose vein surgery in venous leg ulceration. Surgeon, 2016, 14(4): 219-233.
17.	Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet, 2004, 363(9424): 1854-1859.
18.	van Gent WB, Catarinella FS, Lam YL, et al. Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial. Phlebology, 2015, 30(1 Suppl): 35-41.
19.	Linton RR. The post-thrombotic ulceration of the lower extremity: its etiology and surgical treatment. Ann Surg, 1953, 138(3): 415-433.
20.	Marston WA. Efficacy of endovenous ablation of the saphenous veins for prevention and healing of venous ulcers. J Vasc Surg Venous Lymphat Disord, 2015, 3(1): 113-116.
21.	Disselhoff BC, der Kinderen DJ, Kelder JC, et al. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg, 2011, 41(5): 685-690.
22.	Campos W Jr, Torres IO, da Silva ES, et al. A prospective randomized study comparing polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and ulcer. Ann Vasc Surg, 2015, 29(6): 1128-1135.
23.	Li X, Fan L, Ren S, et al. Outcomes of foam sclerotherapy plus ligation versus foam sclerotherapy alone for venous ulcers in lower extremities. Ann Vasc Surg, 2017, 45: 160-165.
24.	Reich-Schupke S, Weyer K, Altmeyer P, et al. Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5% foam. Vasa, 2010, 39(2): 169-174.
25.	Georgiev M. Postsclerotherapy hyperpigmentations: a one-year follow-up. J Dermatol Surg Oncol, 1990, 16(7): 608-610.
26.	Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology, 2014, 29(6): 338-354.
27.	陳鏡全, 曾國軍, 王洪, 等. 大隱靜脈高位結扎加剝脫術中兩種皮膚縫線的效果比較.中國普外基礎與臨床雜志, 2017, 24(5): 593-598.

1. McLafferty RB, Passman MA, Caprini JA, et al. Increasing awareness about venous disease: The American Venous Forum expands the National Venous Screening Program. J Vasc Surg, 2008, 48(2): 394-399.
2. Ghauri AS, Taylor MC, Deacon JE, et al. Influence of a specialized leg ulcer service on management and outcome. Br J Surg, 2000, 87(8): 1048-1056.
3. Bergqvist D, Lindholm C, Nelzén O. Chronic leg ulcers: the impact of venous disease. J Vasc Surg, 1999, 29(4): 752-755.
4. Rice JB, Desai U, Cummings AK, et al. Burden of venous leg ulcers in the United States. J Med Econ, 2014, 17(5): 347-356.
5. Purwins S, Herberger K, Debus ES, et al. Cost-of-illness of chronic leg ulcers in Germany. Int Wound J, 2010, 7(2): 97-102.
6. Rabe E, Pannier F. Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology, 2010, 25 Suppl 1: 64-67.
7. O’Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev, 2012, 11: CD000265.
8. Bello YM, Phillips TJ. Therapeutic dressings. Adv Dermatol, 2000, 16: 253-271.
9. 高薦轅, 金輝. 下肢靜脈性潰瘍診治進展. 中國實用外科雜志, 2015, 35(12): 1355-1358.
10. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg, 2001, 27(1): 58-60.
11. 美國靜脈論壇CEAP分級國際特別委員會. 共識報告——慢性靜脈病變CEAP分級法的修訂. 中華外科雜志, 2006. 44(1): 59-61.
12. Alguire PC, Mathes BM. Chronic venous insufficiency and venous ulceration. J Gen Intern Med, 1997, 12(6): 374-383.
13. Etufugh CN, Phillips TJ. Venous ulcers. Clin Dermatol, 2007, 25(1): 121-130.
14. Partsch H, Flour M, Smith PC, et al. Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. Int Angiol, 2008, 27(3): 193-219.
15. Coleridge-Smith PD. Leg ulcer treatment. J Vasc Surg, 2009, 49(3): 804-808.
16. Kheirelseid EA, Bashar K, Aherne T, et al. Evidence for varicose vein surgery in venous leg ulceration. Surgeon, 2016, 14(4): 219-233.
17. Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet, 2004, 363(9424): 1854-1859.
18. van Gent WB, Catarinella FS, Lam YL, et al. Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial. Phlebology, 2015, 30(1 Suppl): 35-41.
19. Linton RR. The post-thrombotic ulceration of the lower extremity: its etiology and surgical treatment. Ann Surg, 1953, 138(3): 415-433.
20. Marston WA. Efficacy of endovenous ablation of the saphenous veins for prevention and healing of venous ulcers. J Vasc Surg Venous Lymphat Disord, 2015, 3(1): 113-116.
21. Disselhoff BC, der Kinderen DJ, Kelder JC, et al. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg, 2011, 41(5): 685-690.
22. Campos W Jr, Torres IO, da Silva ES, et al. A prospective randomized study comparing polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and ulcer. Ann Vasc Surg, 2015, 29(6): 1128-1135.
23. Li X, Fan L, Ren S, et al. Outcomes of foam sclerotherapy plus ligation versus foam sclerotherapy alone for venous ulcers in lower extremities. Ann Vasc Surg, 2017, 45: 160-165.
24. Reich-Schupke S, Weyer K, Altmeyer P, et al. Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5% foam. Vasa, 2010, 39(2): 169-174.
25. Georgiev M. Postsclerotherapy hyperpigmentations: a one-year follow-up. J Dermatol Surg Oncol, 1990, 16(7): 608-610.
26. Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology, 2014, 29(6): 338-354.
27. 陳鏡全, 曾國軍, 王洪, 等. 大隱靜脈高位結扎加剝脫術中兩種皮膚縫線的效果比較.中國普外基礎與臨床雜志, 2017, 24(5): 593-598.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of therapeutic effects of ligation and stripping of great saphenous vein combined with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer

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