The treatment of venous leg ulcers by compression sclerotherapy

To assess the results of complex sclerotization therapy of pure venous ulcers on all levels of venous system.

Over the last 10 years the authors treated 698 patients with venous ulcerations and compared the therapeutic results in 3 groups of patients treated by Fegan's technique of compression sclerotherapy combined with an antireflux operation of the deep venous system in ulcers not responding to superficial and perforator therapy.

84% of patients with venous ulcers had pathological reflux in the deep venous system and all of them (100%) had insufficiency of the perforators. Using Fegan's technique of compression sclerotherapy the authors managed to heal 95.4% of ulcers with an average time of complete ulcer epithelialization of 39 +/- 12 days. The recurrence rate within 5 years was 18% (126 patients). The average time of disability during the course of sclerotisation was 7 days and no hospitalisation was needed. The healing process depends on the presence of reflux in the popliteal vein in statistically significant fashion. In patients, where a new valve was constructed or direct valvuloplasty was done, all ulcers (except 3) responded to the compression sclerotherapy and healed within 3 months.

The authors consider compression sclerotherapy (Fegan's technique) to be the easiest and most effective way of treating patients with venous ulcers. Direct valve repair techniques are appropriate only in non-thrombotic deep vein reflux which is very rare (0.6% - 4 patients). In patients with torpid ulcers, where compression sclerotherapy failed (4.6% - 28 patients) in situ construction of a new venous valve helped to heal these ulcers. (Tab. 1, Ref. 18.).