Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia / National Cardiovascular Center Harapan Kita / University of Indonesia Academic Hospital, Jakarta, Indonesia.
Departement of Cardiology and Vascular Medicine, Faculty of Medicine Padjadjaran University / Hasan Sadikin General Hospital, Bandung, Indonesia.
F1000Res. 2024 Sep 20;12:383. doi: 10.12688/f1000research.131695.2. eCollection 2023.
Active venous leg ulcer (VLU) is the most severe manifestation of chronic venous disease which not only affects patients' health, but also decreases the quality of life, and delivers economic burdens. Treatment of superficial venous reflux with early endovenous laser ablation (EVLA) has been associated with reducing ulcer recurrence levels and promoting faster VLU healing. We reported three cases of patients with active VLU undergoing EVLA with different approaches.
Three patients came with complaint of leg ulcer, diagnosed with C6sEpAsdPr, with venous clinical severity scores (VCSS) of 15, 23, and 22 respectively. Severe great saphenous veins (GSV) reflux was found in all patients by duplex ultrasound examination. The second patient had undergone above-the-knee EVLA. All patients underwent EVLA using 1470-nano meter wavelength laser device and ELVeS radial fiber (Biolitec, Bonn, Germany). The laser energy protocol used was 6 W linear endovenous energy density (LEED) 50 J/cm for proximal until media ATK GSV ablation, 5 W LEED 40 J/cm for media ATK until proximal below-the-knee (BTK) GSV, and 2 W LEED 20 J/cm for proximal until distal BTK GSV. The third patient was also treated with EVLA for small saphenous vein severe reflux. Follow-up until 6 months post-EVLA showed significant healing of the ulcer with 14, 16, and 17 VCSS reduction consecutively without any complication.
We've reported three cases of patients with active VLU undergoing EVLA until BTK with significant results. The EVLA of GSV until BTK where there is still significant reflux is safe and provides satisfactory results in patients with VLU.
活动性静脉溃疡（VLU）是慢性静脉疾病最严重的表现，不仅影响患者的健康，还降低生活质量，并带来经济负担。早期静脉内激光消融术（EVLA）治疗浅静脉反流可降低溃疡复发水平并促进 VLU 更快愈合。我们报告了 3 例活动性 VLU 患者采用不同方法行 EVLA 的病例。
3 例患者均以腿部溃疡就诊，诊断为 C6sEpAsdPr，静脉临床严重程度评分（VCSS）分别为 15、23 和 22。所有患者的双功能超声检查均发现严重大隐静脉（GSV）反流。第 2 例患者曾行膝上 EVLA。所有患者均采用 1470nm 波长激光设备和 ELVeS 放射状纤维（Biolitec，波恩，德国）行 EVLA。使用的激光能量方案为近端至中膜 GSV 消融的 6W 线性腔内能量密度（LEED）50J/cm，中膜至近段膝下（BTK）GSV 的 5W LEED 40J/cm，以及近端至远段 BTK GSV 的 2W LEED 20J/cm。第 3 例患者还因小隐静脉严重反流而行 EVLA 治疗。EVLA 后随访 6 个月，溃疡愈合明显，VCSS 分别连续减少 14、16 和 17，无任何并发症。
我们报告了 3 例活动性 VLU 患者行至 BTK 的 EVLA 治疗，结果显著。GSV 直至 BTK 仍有明显反流的 EVLA 是安全的，为 VLU 患者提供了满意的结果。
