Table CSurgical treatments for chronic venous ulcers

Superficial venous systemLigation
  • Sapheno-femoral junction/high saphenous ligation involves the ligation and division of the great saphenous vein at the junction with femoral vein.
  • Sapheno-popliteal junction ligation involves the ligation and division of small saphenous vein at its junction with popliteal vein.
  • Ligation of tributaries
  • Saphenous vein stripping involves the ligation and division of the sapheno-femoral junction, followed by stripping a segment of the great saphenous vein to just below the knee using an invagination or inversion catheter.
Stab/micro phlebectomy
  • Stab phlebectomy or micro phlebectomy of tributaries to great or lesser saphenous vein
  • Thermal ablation involves the closing of the great or small saphenous veins using high temperature generated by laser light (endovenous laser treatment) or radiofrequency energy (radiofrequency ablation).
  • Chemical ablation (sclerotherapy) involves injecting an irritant agent (such as sodium tetradecyl sulfate mixed with air or carbon dioxide) into the vein, which results in endothelial damage. Foam preparations increase the potency of sclerosing drug by increasing its surface area.
Perforator venous systemLigation
  • Perforator vein is directly ligated using ultrasound guidance.
Subfascial endoscopic perforator surgery
  • Although rarely performed, this minimally invasive surgical procedure involves use of an endoscope through the unaffected area of skin and fascia. An elastic wrap is used to empty the leg veins of blood then a tourniquet is placed at the thigh. Clinicians insufflate the subfascial space with carbon dioxide. This creates a space for the endoscope to identify and ligate the Cockett's perforating veins in the lower calf.
  • Thermal ablation of perforator veins (radiofrequency ablation)
  • Chemical ablation (sclerotherapy) of perforator veins
Hach procedure
  • This procedure involves paratibial fasciotomy and dissection of the posterior perforator veins.
Deep venous systemObstructive
  • This involves bypassing the obstructive segment of deep vein using autogenous vein or polytetrafluoroethylene synthetic graft
  • This involves balloon angioplasty with or without stenting of the stenotic area of the deep vein
  • Valve replacement (transposition or transplant) involves the replacement of the affected deep venous valve with an autogenous vein valve from the upper extremity.
  • Valvuloplasty involves repairing or reconstructing valves in the deep venous system of the lower limb.

From: Executive Summary

Cover of Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities
Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities [Internet].
Comparative Effectiveness Reviews, No. 127.
Zenilman J, Valle MF, Malas MB, et al.

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