Endovenous laser treatment of saphenous and perforators reflux for leg ulcers in primary chronic venous insufficiency

Aim. Venous leg ulcers are usually related to incompetent perforating veins also in primary chronic venous insufficiency. The need for new surgical strategies and techniques to overcome the barriers to effective treatment of this problem is always actual. We present a recent and larger experience in two Centres of IEWG and long-term results from a retrospective analysis of controlled patients versus the same number of randomized ones for the standard treatment with stripping, assessing some aspects of techniques, healing and recurrence rates. Methods. Between Jan 2002 and Dec 2006, 560 consecutive patients with an active venous leg ulcers, previously medically treated (not showing any sign of improvement after 4 weeks), qualified for the study. 280 were randomized for endovenous laser treatment of saphenous vein and/or perforator veins (A); 280 were randomized to stripping and/or perforators interruption (B). Results. The prevalence of IPVs reflux was high (42%) and comparable in both settings A and B. In a three-years follow-up, 226/280 group A patients and 231/280 group B patients underwent valid controls. Healing time showed to be shorter in group A and, when compared to the types of reflux, came to be significantly shorter only in group A patients with a brief and isolated reflux and with associated long/brief when compared to the same types within group B. Healing time showed no significant differences in both groups with single long reflux. In the whole, recurring percentage was lower in group A. Conclusion. Based our data and positive personal experience with ELT, particularly in the subgroups with IPVs reflux, the elimination of this reflux with a minimal surgical trauma of laser is expected to result in ulcer healing of most leg ulcers with primary CVI, reducing 3-years ulcer recurrence; whereas the value of such treatment for the saphenous reflux only is not clear.