Leg ulcers are all too common, and patients often either do not seek assistance, or are referred far too late, in the mistaken belief that there is nothing that can be done to help. Ulcers often have an underlying vascular cause. Thus, there is often something that can be done to help in three phases: ulcer prevention, ulcer healing, and prevention of ulcer recurrence.
There is usually a stage where severe skin changes due to chronically elevated venous pressures results in skin discoloration, swelling, induration and eczema. This can readily lead to ulceration. Treatment is particularly effective at preventing ulceration if undertaken at this stage before ulceration supervenes.
If there is already an ulcer, and the cause is predominantly venous, then the usual endovenous treatments ought to be used early to accelerate ulcer healing. Similarly, endovenous treatments will be effective in preventing ulcer recurrence. These are policies I have espoused and used for decades, with great success.
This gentleman had very severe venous eczema discoloration and swelling which responded perfectly to MOCA of his wide refluxing greater saphenous vein though only a single puncture as a sole procedure.
This gentleman had sustained recurrent episodes of ulceration. He had a very wide refluxing greater saphenous vein and this was treated by endoluminal bioadhesive closure, through a single puncture. His skin changes improved greately, and his risk of further ulceration is hugely reduced.
The results of the ESCHAR and EVRA surgical trials indicate that early venous intervention provide more rapid venous ulcer healing and reduce ulcer recurrence than without intervention. As such, all ulcers with a venous origin ought to be treated early, even in the presence of current ulcreation.
These are two cases of active ulceration both treated with endovenous procedures. luminal bioadhesive closure of the culprit greater saphenous veins. The top (smaller) ulcer was purely venous in origin and healed in six weeks after endoluminal bioadhesive closure. The bottom (large) ulcer was multifactorial in origin, but eventually came to total healing in one year with nursing attention, and abolition of the superficial venous reflux using MOCA.