Contemporary Multi-modal Surgical Therapy Allows for Durable Healing of Venous Stasis Ulceration
Rachel Reed, Savannah Smith, Rachel M Lee, Mustafa Khader, Christopher Ramos, Jaime Benarroch-Gampel, Keri Minton, Ravi Rajani
Emory University, Atlanta, GA
Introduction: Chronic venous disease (CVD) has a high prevalence in the United States, with estimates of 1-1.5% of the population estimated to have healed or active ulcers. Surgical therapy often involves a variety of procedures aimed at treating underlying superficial and deep venous pathology. We sought to evaluate the effects of a contemporary, multi-modal approach to surgical therapy of advanced venous disease.Methods: A retrospective review of all patients treated with chronic venous ulceration (C6 disease) was performed at a single, public academic hospital for the years 2011-2021. The primary outcome measure was ulcer-free survival at one year following the initiation of surgical therapy, which included venous ablation, deep venous stenting, and open deep venous valvuloplasty. Standard demographic and procedural outcomes were assessed. Results: Fifty-three total patients were identified. Twenty-nine patients were ulcer-free at one year (54%). There were no significant demographic differences between those patients who healed and those that did not (Table 1). In all, 37.7% of patients required more than one type of procedure. 71.7% underwent isolated venous ablation, 13.2% underwent isolated iliac vein stenting, and 1.8% underwent isolated valvuloplasty. The number and type of procedures performed did not correlate with ulcer healing. The initial venous clinical severity score (VCSS) and history of deep venous thrombosis (DVT) also did not predict ultimate ulcer-free survival.Conclusion: In this single-center analysis of contemporary surgical therapy of venous stasis ulceration, patients with high-risk features (advanced VCSS, mixed superficial and deep disease, mixed obstructive and reflux disease) were able to be healed at similar rates at one-year. Providers caring for this complex group of patients should be well equipped to offer a variety of intervention types to achieve optimal results.
| Ulcer Free at 12 months (N=29) | Not healed at12 months (N = 24) | P value | |
| Average Age (years) | 53.7 +/- 10.19 | 48.45 +/- 11.12 | 0.114 |
| Gender | 0.15 | ||
| Female | 10 (35.5%) | 13 (54.2%) | |
| Male | 19 (65.5%) | 11 (45.8%) | |
| Insurance | 0.817 | ||
| Insured (%) | 16 (55.2%) | 14 (58.3%) | |
| Uninsured (%) | 13 (44.8%) | 10 (41.7%) | |
| Diabetes | 0.832 | ||
| Diabetic | 8 (27.6%) | 6 (25%) | |
| Not Diabetic | 21 (72.4%) | 18 (75%) | |
| BMI | 0.591 | ||
| BMI < 30 | 10 (34.5%) | 10 (41.7%) | |
| BMI > 30 | 19 (65.5%) | 14 (58.3%) | |
| History of DVT | 0.269 | ||
| History of DVT | 9 (31%) | 11 (55%) | |
| No History of DVT | 20 (69%) | 9 (45%) | |
| Pre-intervention VCSS | 12 +/- 3.99 | 11.09 +/- 2.76 | 0.388 |
| Post-intervention VCSS | 6.10 +/- 3.11 | 8.73 +/- 4.38 | 0.029 |
| Average number Venous ablations | 1.10 +/- 0.77 | 0.95 +/- 0.79 | 0.556 |
| Average number of stents | 0.24 +/- 0.54 | 0.55 +/-0.74 | 0.128 |
| Average number of deep venous reconstruction | 0.952 +/- 0.30 | 0.136 +/- 0.351 | 0.683 |
| Average number of total procedures | 1.48 +/- 0.750 | 1.9545 +/- 1.56 | 0.210 |
| One Procedure | 21 (72.4%) | 12 (50%) | 0.094 |
| Multiple Procedures | 8 (27.6%) | 12 (50%) |
Table 1. Patient characteristics compared between the ulcer free and not ulcer free groups.
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