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    • Ultrasound guided sclerotherapy injection of subulcer venous plexus for treatment of chronic venous ulcer

    Ahmed Sawaby1, Islam Atta2, Amr El Abd3,Mohsen Ahmed Abdelmohsen4
    1Lecturer of Vascular Surgery, Faculty of Medicine, Port Said University, Egypt. Prior: Consultant of Vascular Surgery at Alexandria University Hospital 2Lecturer of Vascular Surgery, Faculty of Medicine, Aswan University, Egypt. 3Assisstant Professor of Radiodiagnosis, Faculty of Medicine, Alexandria University, Egypt. 4Lecturer of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Egypt.

    Objectives: Venous hypertension contribute to venous ulceration. We sought to describe patient characteristics and procedural factors that impact rates of sub ulcer venous plexus (SUV) thrombosis through injection with ultrasound-guided sclerotherapy (UGS) for the healing of venous ulcers without axial reflux. Material and Methods: Retrospective review of UGS of SUV injections from 2/2018–9/2018 identified 47 treated venous ulcers in 47 patients. Patients had no other superficial/axial reflux and were treated with standard wound care and compression therapy for three months. Ultrasound was used to screen for venous plexus beneath and near ulcer(s), superficial to deep fascia, and these were injected with polidocanol foam and assessed for thrombosis. Demographic data, comorbidities, treatment details and outcomes were analyzed. Univariate and multivariable modeling was performed to determine covariates predicting SUV thrombosis and ulcer healing. Results: 47 patients with active ulcers for an average of 8 months with compression therapy prior to subulcer plexus treatment had an average age of 44 years, were 85% male and 78.7% had a history of DVT. Ulcers were treated with SUV injections, with average successful closure rate of 85%. Of 47 ulcers, 38 patients (80.9%) healed ulcers, while 9 patients (19.1%) had non-healed ulcer(s) in mean follow-up of 3 months. Patients that healed ulcers had an SUV closure rate of 97.4 % vs. 33.3% in patients who did not heal (P<.001). Multivariate models demonstrated initial ulcer size and ulcer duration negatively predicted thrombosis of SUV .Multivariate model for ulcer healing found complete SUV thrombosis was a positive predictor (P=.001), while repeated injection sessions was a negative predictor (P=.007). Conclusions: Thrombosis of SUV with UGS increases venous ulcer healing in a difficult patient population. Complete closure of all SUVs in an ulcerated limb was the only predictor of ulcer healing. The failure of complete closure after first session have decreased rates of SUV thrombosis with UGS. Keywords: Venous ulcer, ultrasound guided, sclerotherapy injection. 

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