Venous leg ulcers (CEAP 6) represent the severest form of chronic venous insufficiency. As closure techniques for superficial venous reflux evolve, direct outcome comparisons of treatments are integral as many studies have already demonstrated early endovenous intervention improves wound healing. This study aims to compare rates of venous wound healing between two techniques of superficial vein closure: ClosureFast radiofrequency ablation (RFA) and adhesive closure (VenaSeal).
A multi-institutional retrospective review of all CEAP 6 patients who underwent closure of their truncal veins from 2015-2020 was performed. Patients undergoing RFA were compared to those undergoing VenaSeal adhesive closure. Primary endpoint was time to wound healing from initial vein closure. Secondary endpoints included ulcer recurrence and infection rates. Bivariate analysis involved Chi-square, Fisher’s Exact, T and Wilcoxon rank sum tests. Multivariate linear regression analysis examined factors affecting time to wound healing in the most predictive model. Statistical significance was defined as p value <0.05.
119 CEAP 6 patients were included with median follow-up of 105 days [IQR: 44-208]. 68 limbs were treated with RFA and 51 limbs treated with VenaSeal. Significantly more patients undergoing RFA had a history of DVT (29% vs. 10%, p=0.01) and deep venous reflux (82% vs. 51%, p=0.003). The VenaSeal patients were older (72 years vs. 65 years, p=0.02) with a higher rate of CAD (16% vs.37%, p=0.01). Median time to wound healing after procedure was significantly shorter for VenaSeal than RFA (43 vs. 104 days, p=0.001). Two RFA patients had post-procedure infection. Ulcer recurrence rate was 19.3% (22.1% RFA vs 13.7% VenaSeal p=0.25). On multivariate analysis, treatment modality was the only significant predictor of time to wound healing. Controlling for ulcer size categorized into small (3cm), VenaSeal closure significantly healed wounds faster in all ulcers.
ClosureFast and VenaSeal are both safe and effective treatments to eliminate truncal venous insufficiency. VenaSeal has superior time to wound healing compared to ClosureFast in both large and small ulcers.
Copyright © 2021. Published by Elsevier Inc.