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Non-thermal Modalities Are A Key Element To Wound Healing In Ceap 6 Patients
Leigh Ann O'Banion, MD
1,
Christian Anthony Campat, DO1, Masaki Kiguchi, MD
2, Juan Carlos Jimenez, MD
3, Ulka Sachdev, MD
4, Niyati Bhatt
5, Alexander Rothstein, BM, BA
4, Julie Bitner, BA
4.
1UCSF Fresno, Fresno, CA, USA,
2MedStar Health, Washington DC, DC, USA,
3UCLA Gonda Venous Center, UCLA, CA, USA,
4UPMC, Pittsburgh, PA, USA,
5Georgetown University, Washington DC, DC, USA.
Objectives: Early endovenous intervention of the saphenous system improves healing and recurrence of venous leg ulcers (CEAP-6). As ablative methods continue to evolve, it is essential to identify outcome differences between the various techniques. This study aims to compare wound healing rates between primary non-thermal [cyanoacrylate (CAG) or commercial polidocanol microfoam (MFA)] and thermal with adjunct MFA.
Methods: In this multi-center retrospective cohort study, patients with healed venous ulcers after non-thermal endovenous treatment were identified from four tertiary referral US institutions. Demographics, co-morbidities, procedural, and wound data were collected. Patients whose full-length great saphenous vein (GSV) was treated with a single non-thermal modality (CAG or MFA) were compared to those treated with RFA + MFA of the below knee segment. Multivariate linear regression was performed to identify predictors of wound healing.
Results: 55 patients were identified (27 primary CAG or MFA and 28 RFA+MFA). The average age was 70±12, 56% were male, and 53% had BMI>30kg/m
2. Co-morbidities were similar between the cohorts. Median ulcer size was 3cm
2. Median time to wound healing was 61 days (IQR 30-258) with no significant difference between treatment modalities (p=0.37), irrespective of ulcer size category (Figure 1). Rate of ulcer recurrence was 16% and did not differ between the cohorts (p=0.46). Multivariate linear regression identified proximal access site as the only independent predictor of prolonged wound healing (p=0.03).
Conclusions: Treatment of the full-length GSV with single non-thermal modality (CAG or MFA) or thermal plus MFA below the knee have comparable time to wound healing. This suggests comprehensive treatment of the entire GSV to the ankle is the preferred approach for optimal wound healing in CEAP-6 patients.
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