Andrej Sikovec: Endovenous Laser Treatment Of Varicose Veins
Venous ulcer of the calf is the most advanced stage of chronic venous insufficiency failure (CVI). The prevalence of active and healed ulcers is around 1%, but it rises to approximately 3% in the elderly population.
With the development of ultrasound diagnostics, it became clear that the underlying cause of venous ulcer of the lower leg is the reflux in superficial veins, and that incompetent perforating veins are the result of superficial reflux. Studies have shown that by removing superficial reflux and incompetent perforators, the rapid healing of ulcers can be achieved.
Surgical therapy, in addition to other non-invasive therapy (external compression, drugs that affect the inflammatory response), is focused on eliminating venous reflux in superficial veins and perforating veins.
In non-healing ulcers, it is necessary to accede to the intervention to reduce the pressure in the intrafascial compartment of the lower leg. This is the case in ulcers that have lasted for years because of fibrozation of the subcutaneous tissue and fascia. This causes a permanent increase of the subfascial pressure (5). In such a case, it is necessary to remove all of the ulcer together with the subcutaneous tissue and muscle fascia.
At the Avelana clinic for vascular surgery, we have developed an approach to treating patients with venous ulcer of the lower leg using Nd:YAG endovenous laser ablation that enables quick healing of ulcers in almost all patients.
