Jarosław Kalemba, Grzegorz Krasowski
SURGICAL TREATMENT OF VENOUS REFLUX
IN PATIENTS WITH LEG ULCERS –
SAPHENECTOMY,
ENDOL...
More than 60% of leg ulcers are
venous ulcers
Type of leg
ulcer
Right Left
Venous 61% 60%
Arterial 14% 18%
Mixed 19% 15%
O...
Reccurences of venous ulcers is a problem for
patients and for medical staff.
How to improve the
prognosis?
How to reduce ...
The most important step in the treatment of venous leg ulceration is
to stop venous reflux.
We can easly do it using surgi...
Preferred procedures
in the treatment of
venous reflux in
patients with venous
leg ulcers
The prefered procedures
GSV:
Thigh – endolaser
Calf –miniphlebectomy
Ulcer region – sclerotherapy
SSV:
Calf – endolaser,
m...
Endovenous laser therapy
Active ulcer:
- removing old dressing
- mechanical debridement if needed
- antiseptic solutions
-...
Saphenectomy
Saphenectomy is a traditional surgical method of
elimination of venous reflux
We have to cut the groin, tie a...
Sclerotherapy
Foam sclerotherapy - more effective
Liquid sclerotherapy
Preferred in patients when invasive procedures are
...
Summary
1. Leg ulcers are mainly caused by venous
insufficiency.
2. We know how to treat reflux in superficial veins.
3. I...
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EWMA 2013 - Ep523 - SURGICAL TREATMENT OF VENOUS REFLUX IN PATIENTS WITH LEG ULCERS – SAPHENECTOMY, ENDOLASER ABLATION, MINIPHLEBECTOMY, SCLEROTHERAPY - TWENTY YEARS OF EXPERIENCE

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Jarosław Kalemba, Grzegorz Krasowski

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EWMA 2013 - Ep523 - SURGICAL TREATMENT OF VENOUS REFLUX IN PATIENTS WITH LEG ULCERS – SAPHENECTOMY, ENDOLASER ABLATION, MINIPHLEBECTOMY, SCLEROTHERAPY - TWENTY YEARS OF EXPERIENCE

  1. 1. Jarosław Kalemba, Grzegorz Krasowski SURGICAL TREATMENT OF VENOUS REFLUX IN PATIENTS WITH LEG ULCERS – SAPHENECTOMY, ENDOLASER ABLATION, MINIPHLEBECTOMY, SCLEROTHERAPY - TWENTY YEARS OF EXPERIENCE
  2. 2. More than 60% of leg ulcers are venous ulcers Type of leg ulcer Right Left Venous 61% 60% Arterial 14% 18% Mixed 19% 15% Other 6% 7%
  3. 3. Reccurences of venous ulcers is a problem for patients and for medical staff. How to improve the prognosis? How to reduce the number of recurrences ?
  4. 4. The most important step in the treatment of venous leg ulceration is to stop venous reflux. We can easly do it using surgical methods. Endolaser therapy is a good way to stop venous reflux in superficial veins. We can use surgical methods like stripping or miniphlebectomy. Sclerotherapy is a complementary but sometimes the only usable method.
  5. 5. Preferred procedures in the treatment of venous reflux in patients with venous leg ulcers
  6. 6. The prefered procedures GSV: Thigh – endolaser Calf –miniphlebectomy Ulcer region – sclerotherapy SSV: Calf – endolaser, miniphlebectomy Ulcer region – sclerotherapy
  7. 7. Endovenous laser therapy Active ulcer: - removing old dressing - mechanical debridement if needed - antiseptic solutions - implementation of the new dressing - laser ablation GSV or SSV - miniphlebectomy in the proximal part of the calf - sclerotherapy of distal part of the calf - compression. - Rp.: LMWH for 10 days - Rp.: non-steroidal anti-inflammatory drugs,oraly in the case of pain,
  8. 8. Saphenectomy Saphenectomy is a traditional surgical method of elimination of venous reflux We have to cut the groin, tie and cut the saphenous vein, enter the striper and pull out saphenous vein trunk. Saphenectomy needs additional procedures as miniflebectomy or/and sclerotherapy. We can make it during the same operation or after 4-6 weeks.
  9. 9. Sclerotherapy Foam sclerotherapy - more effective Liquid sclerotherapy Preferred in patients when invasive procedures are contraindicated because of the general health status. Excellent complementary method after EVLT or after saphenectomy
  10. 10. Summary 1. Leg ulcers are mainly caused by venous insufficiency. 2. We know how to treat reflux in superficial veins. 3. It is very important to use a more invasive treatment than only the dressings and compression therapy. 4. Properly chosen dressings and compression therapy constitute an essential component for improving treatment.

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