Jarosław Kalemba, Grzegorz Krasowski

1. Jarosław Kalemba, Grzegorz Krasowski
SURGICAL TREATMENT OF VENOUS REFLUX
IN PATIENTS WITH LEG ULCERS –
SAPHENECTOMY,
ENDOLASER ABLATION, MINIPHLEBECTOMY,
SCLEROTHERAPY
- TWENTY YEARS OF EXPERIENCE

2. More than 60% of leg ulcers are
venous ulcers
Type of leg
ulcer
Right Left
Venous 61% 60%
Arterial 14% 18%
Mixed 19% 15%
Other 6% 7%

3. Reccurences of venous ulcers is a problem for
patients and for medical staff.
How to improve the
prognosis?
How to reduce the
number of recurrences ?

4. The most important step in the treatment of venous leg ulceration is
to stop venous reflux.
We can easly do it using surgical methods.
Endolaser therapy is a good way to stop venous reflux in superficial veins.
We can use surgical methods like stripping or miniphlebectomy.
Sclerotherapy is a complementary but sometimes the only usable method.

5. Preferred procedures
in the treatment of
venous reflux in
patients with venous
leg ulcers

6. The prefered procedures
GSV:
Thigh – endolaser
Calf –miniphlebectomy
Ulcer region – sclerotherapy
SSV:
Calf – endolaser,
miniphlebectomy
Ulcer region – sclerotherapy

7. Endovenous laser therapy
Active ulcer:
- removing old dressing
- mechanical debridement if needed
- antiseptic solutions
- implementation of the new dressing
- laser ablation GSV or SSV
- miniphlebectomy in the proximal part of the calf
- sclerotherapy of distal part of the calf
- compression.
- Rp.: LMWH for 10 days
- Rp.: non-steroidal anti-inflammatory drugs,oraly in the case of pain,

8. Saphenectomy
Saphenectomy is a traditional surgical method of
elimination of venous reflux
We have to cut the groin, tie and cut the saphenous vein,
enter the striper and pull out saphenous vein trunk.
Saphenectomy needs additional procedures as
miniflebectomy or/and sclerotherapy. We can make it
during the same operation or after 4-6 weeks.

9. Sclerotherapy
Foam sclerotherapy - more effective
Liquid sclerotherapy
Preferred in patients when invasive procedures are
contraindicated because of the general health
status.
Excellent complementary method after EVLT or
after saphenectomy

10. Summary
1. Leg ulcers are mainly caused by venous
insufficiency.
2. We know how to treat reflux in superficial veins.
3. It is very important to use a more invasive treatment
than only the dressings and compression therapy.
4. Properly chosen dressings and compression therapy
constitute an essential component for improving
treatment.