Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Loyola University Medical Center, Maywood, IL.
Loyola University Chicago Stritch School of Medicine, Maywood, IL.
Ann Vasc Surg. 2022 Nov;87:237-244. doi: 10.1016/j.avsg.2022.04.031. Epub 2022 Apr 23.
The goal of this study is to compare the healing rates of active lower extremity venous ulcers for patients receiving one of 3 ablation methods, compare their complications, and identify factors affecting successful healing and prevention of recurrence.
For this study, data were collected retrospectively on 146 patients at a single institution, tertiary referral center, with an active venous ulcer who underwent ablation therapy via cyanoacrylate (VenaSeal), radiofrequency (RFA), or endovenous laser ablation (EVLA) from 2010 to 2020.
The study showed a nonsignificant difference in days to ulcer healing postintervention between ablative techniques, with 80.8 days for cyanoacrylate ablation (n = 15), 70.07 for RFA (n = 44), and 67.04 days for EVLA (n = 79). A similar, nonsignificant trend was observed for ulcer recurrence, with a rate of 35.7% (5/14) for cyanoacrylate ablation, 26.7% (20/75) for EVLA, and 23.1% (9/39) for RFA. The same nonsignificant trend occurred with deep venous thrombosis following the procedure in 6.3% (1/16) of cyanoacrylate ablation, 4.8% (4/84) of EVLA, and 2.2% (1/46) of RFA cases. The rate of endovenous glue induced thrombosis was also higher (6.3%) for cyanoacrylate than endovenous heat induced thrombosis in EVLA (3.6%) and RFA (2.2%). Cox proportional hazard was significant for compliance with compression therapy (hazard ratio [HR] 2.12, confidence interval [CI] 95% = 1.10-4.20, P = 0.031) and a lack of working with a wound clinic (HR 0.50, CI 95% = 0.33-0.75, P = 0.001) were associated with the decreased time to healing of ulcer but was not influenced by the presence of other comorbidities of smoking or diabetes mellitus.
This study indicates a trend toward cyanoacrylate ablation having longer healing times and more complications compared to other ablation methods when used in patients with active venous ulcers. Compliance with compression treatment is predictive of venous ulcer healing and working with a wound clinic had significantly longer healing times.
本研究的目的是比较接受三种消融方法之一的患者的活动性下肢静脉溃疡的愈合率，比较其并发症，并确定影响愈合成功和预防复发的因素。
在这项研究中，回顾性地收集了 2010 年至 2020 年间在一家三级转诊中心接受氰基丙烯酸酯（VenaSeal）、射频（RFA）或静脉内激光消融（EVLA）消融治疗的 146 例活动性静脉溃疡患者的数据。
研究表明，消融技术之间的干预后溃疡愈合天数无显著差异，氰基丙烯酸酯消融为 80.8 天（n=15），RFA 为 70.07 天（n=44），EVLA 为 67.04 天（n=79）。溃疡复发也呈现出类似的无显著趋势，氰基丙烯酸酯消融的复发率为 35.7%（5/14），EVLA 为 26.7%（20/75），RFA 为 23.1%（9/39）。术后深静脉血栓形成也呈无显著趋势，氰基丙烯酸酯消融为 6.3%（1/16），EVLA 为 4.8%（4/84），RFA 为 2.2%（1/46）。静脉内胶诱导血栓形成的发生率也高于 EVLA 静脉内热诱导血栓形成的发生率（6.3%比 3.6%和 2.2%）。Cox 比例风险对符合压缩治疗（危险比 [HR] 2.12，置信区间 [CI] 95%=1.10-4.20，P=0.031）和缺乏与伤口诊所合作（HR 0.50，CI 95%=0.33-0.75，P=0.001）有显著意义，与溃疡愈合时间缩短有关，但不受吸烟或糖尿病等其他合并症的影响。
本研究表明，与其他消融方法相比，在活动性静脉溃疡患者中，氰基丙烯酸酯消融的愈合时间更长，并发症更多。对压缩治疗的依从性是静脉溃疡愈合的预测因素，与伤口诊所合作具有显著更长的愈合时间。
