U NNA B OOT Used to treat a Venous Stasis Ulcer Ashley Webb.
WHY WON’T THIS VENOUS ULCER HEAL?
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WHY WON’T THIS VENOUS WHY WON’T THIS VENOUS ULCER HEAL?ULCER HEAL?
Noel Parent MD, FACS, RVTNoel Parent MD, FACS, RVT
SENTARA VASCULAR SPECIALISTSSENTARA VASCULAR SPECIALISTS
Virginia Beach, VAVirginia Beach, VA
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Variety of leg ulcer etiologyVariety of leg ulcer etiology
Decubitis (pressure)Decubitis (pressure) at points of contactat points of contact
Ischemic (arterial)Ischemic (arterial) malperfusionmalperfusion
InfectiousInfectious Foreign bodyForeign body Rheumatologic or Rheumatologic or
autoimmuneautoimmune VenousVenous
Venous hypertensionVenous hypertension
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Venous ulcer characteristicsVenous ulcer characteristics
Ulcer location is Ulcer location is medial lower calf just medial lower calf just above the ankleabove the ankle
Hemosiderin Hemosiderin depositiondeposition
LipodermatosclerosisLipodermatosclerosis EdemaEdema Size variableSize variable Varicose veins +/-Varicose veins +/-
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It all begins with loss of venous It all begins with loss of venous valve function (venous reflux)valve function (venous reflux)
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Importance of the perforating veinsImportance of the perforating veins
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Elevated pressure within the veins of Elevated pressure within the veins of the calf skin is the pathophysiologythe calf skin is the pathophysiology
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How to decrease venous pressure?How to decrease venous pressure?
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Traditional surgical treatmentTraditional surgical treatment
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Why vein ulcers…Why vein ulcers…
……did not heal in the did not heal in the past:past: INADEQUATE INADEQUATE
DIAGNOSTIC DIAGNOSTIC IMAGINGIMAGING
IMPRECISE IMPRECISE INVASIVE INVASIVE TREATMENTSTREATMENTS
……why they may heal why they may heal now:now: DUPLEX DUPLEX
ULTRASOUND ULTRASOUND IMAGING FOR VEIN IMAGING FOR VEIN MAPPINGMAPPING
EVLT IS PRECISE EVLT IS PRECISE AND MINIMALLY AND MINIMALLY INVASIVEINVASIVE
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Duplex ultrasound perforator vein Duplex ultrasound perforator vein imaging to access for ablationimaging to access for ablation
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Percutaneous fiberoptic laser Percutaneous fiberoptic laser delivery of thermal energydelivery of thermal energy
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SVS Vein Center of VirginiaSVS Vein Center of Virginia
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Perforator vein identified by duplex scanPerforator vein identified by duplex scan
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Perforator vein cannulationPerforator vein cannulation
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Insertion of laser fiberopticInsertion of laser fiberoptic
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Tumescence anesthesiaTumescence anesthesia
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Ablation of perforator veinAblation of perforator vein
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Case example #1Case example #1
Very dirty ankle venous Very dirty ankle venous ulcer in an elderly female.ulcer in an elderly female.
Complex PVL showing: chronic Complex PVL showing: chronic thrombus in GSV. Note associated thrombus in GSV. Note associated SSV reflux and two incompetent SSV reflux and two incompetent calf perforator veins.calf perforator veins.
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Case example #1, cont’dCase example #1, cont’d PVL confirms successful PVL confirms successful
ablation of GSV, SSA and ablation of GSV, SSA and perforators. perforators.
6 weeks post endovenous laser 6 weeks post endovenous laser treatment: ulcer healing for the treatment: ulcer healing for the FIRST TIME IN A YEARFIRST TIME IN A YEAR!!
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Case example #2Case example #2
Pre treatmentPre treatment Post treatmentPost treatment
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Retrospective study of EVLT for Retrospective study of EVLT for venous ulcers in SVS/VCVvenous ulcers in SVS/VCV
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Compared 3 groups of patientsCompared 3 groups of patients
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Incidence of ulcer healingIncidence of ulcer healing
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Improvement in VCSSImprovement in VCSS
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Minimal complicationsMinimal complications
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SummarySummary Leg ulcers are commonly due to elevated Leg ulcers are commonly due to elevated
venous pressure in skin from valve weakness venous pressure in skin from valve weakness resulting in reflux.resulting in reflux.
Results from traditional therapies of Unna Results from traditional therapies of Unna boots, stockings, and open surgery are boots, stockings, and open surgery are disappointing. (Costly, morbid, disabling)disappointing. (Costly, morbid, disabling)
A contemporary treatment consisting of A contemporary treatment consisting of duplex scan diagnosis of perforating veins, duplex scan diagnosis of perforating veins, then treatment by EVLT, may become the then treatment by EVLT, may become the new standard of care.new standard of care.
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The End – thank youThe End – thank you