Sources Of Venous Reflux With Venous Stasis Recurrence
Andy Moyal, BA1,7, Lindsey Euscher, MS2,7, Christine Lee, BS3,7, Adrienne Green, MD, MHS4,7, Samantha Hanley, BS5,7, Natalie Marks, MD6,7, Enrico Ascher, MD6,7, Anil Hingorani, MD6,7.
1New York Institute of Technology College of Osteopathic Medicine, Old Westbury NY, USA; 2University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA; 3Virginia Commonwealth University School of Medicine, Richmond, VA, USA; 4New York Presbyterian Queens Hospital, General Surgery Program, Flushing, NY, USA; 5SUNY Upstate Medical University, Norton College of Medicine, Syracuse, NY, USA; 6NYU Langone – Brooklyn, Brooklyn, NY, USA; 7Total Vascular Care, Brooklyn, NY, USA
OBJECTIVES: Venous stasis ulcers are associated with significant morbidity, cost, and recurrence. This retrospective study sought to determine factors that may contribute to ulcer recurrence such as failed ablations that were initially successful, new sources of reflux, and continued reflux in untreated veins.
METHODS: We reviewed the charts of patients who had venous stasis ulcers between 2012 and 2021. We identified which patients had ulcers and underwent ablation therapy. Venous mapping data was collected when the patient first presented with an ulcer and when they had an ipsilateral ulcer recurrence. Ablation data was collected from the time interval between the patient's first ulcer visit and the date of ulcer recurrence. We then identified which superficial venous segments, for limbs that had ablation therapy and ulcer recurrence, had continued or new venous reflux.
RESULTS: 298 patients presented with 420 limbs with venous stasis ulcers, 147 left extremities, 149 right extremities, and 124 bilateral. The mean age was 70.1 years (Range=28-95, SD=13.7). Of these 420 limbs 218 had ablations and of these 135 had recurrent ulcers. Upon recurrence, duplex exams revealed that 6 ablations had failed: 1-AK-GSV, 2-BK-GSV, 2-SSV, and 1-ASV. Ablation procedures were as follows: for the left extremity, 102-AK-GSV, 43-BK-GSV, 71-SSV, and 23-ASV. For the right extremity, 108-AK-GSV, 22-BK-GSV, 71-SSV, and 21-ASV. New sources of reflux for the left extremity were as follows: 3-AK-GSV, 12-BK-GSV, 5-SSV, and 2-ASV. Continued untreated reflux for the left extremity was as follows: 9-AK-GSV, 1-BK-GSV, 9-SSV, and 0-ASV. New sources of reflux for the right extremity were as follows: 2-AK-GSV, 8-BK-GSV, 6-SSV, and 1-ASV. Continued untreated reflux for the right extremity was as follows: 7-AK-GSV, 2-BK-GSV, 6-SSV, and 0-ASV. Of the 135 limbs with ulcer recurrence, 37/68 had an ipsilateral stent on the left, and 33/67 had an ipsilateral stent on the right. The average time to ulcer recurrence was 334.2 days (Range=5-2726, SD=523.8).
CONCLUSIONS: Our results suggest that patients should be treated aggressively with ablation therapy early on in their disease and upon follow-up. The data demonstrated new reflux in a substantial amount of limbs that underwent prior ablation therapy for other venous segments.
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