Case study
A unique case of treating trophic leg ulcers without surgery using foam sclerotherapy, under ultrasound control. Dr. Khairbeik Aksam Ali, surgeon, surgeon - phlebologist
Treatment of varicose veins of the lower extremities and trophic ulcers of the leg of venous origin with foam sclerotherapy, under ultrasound control.
The latest advances in sclerotherapy associated with the use of foam have expanded the indications for the treatment of varicose veins of the lower extremities. One of the indications for the treatment of venous insufficiency of the lower extremities is trophic ulcers of the legs of venous origin.
This case shows how important it is to examine and treat venous valve insufficiency in the treatment of trophic ulcers of varicose origin.
Трофические язвы голеней венозного происхождения, являются конечной стадией хронической венозной недостаточности (хвн). Если имеет место несостотяльность клапанов поверхностных вен нижних конечностей, то неоперативное лечение несостоятельности клапанов пенной склеротерапией под контролом ультразвука следует рассматривать как эффективное и быстрое решение проблемы.
Our unique case is the case where ultrasound-guided foam sclerotherapy was used to treat trophic ulcers of the shin of venous origin with great success, despite the long history of these ulcers (31 years).
In December 2011, patient K., 62 years old, came to us with complaints of varicose veins of the lower extremities and trophic ulcers of the medial surface of the right shin. In this patient, the ulcers were painless, this is due to deep changes in the soft tissues around them and their cartilaginous consistency. These deep changes led to the disappearance of pain sensitivity. In most cases, such ulcers cause the patient severe, persistent, round-the-clock pain that is not relieved by conventional painkillers.
There was a history of varicose veins and a trophic ulcer of the left lower limb, for which surgical treatment was performed in 1981.
Ulcers on the right shin began to appear in 1981, against the background of varicose veins of the right lower limb. At the time of treatment, the following were present on the right shin: one large ulcer 13 cm x 5 cm x 3 cm, a 2nd ulcer 5 cm in diameter and 1 cm deep, and a 3rd ulcer 3 cm in diameter and 1 cm deep.
There was no history of thrombophlebitis or thrombosis. No other features were noted either.
Ulcer care was routine, with dressings and antiseptic ointments.
After the examination, duplex scanning of the veins of the lower extremities was performed. As a result, dilation and insufficiency of the valves of the right great saphenous vein, the accessory right great saphenous vein and many of their tributaries were revealed. The deep veins and the small saphenous vein of the right lower limb are normal.
Duplex scanning of the veins of the left lower limb revealed a relapse of varicose disease with dilation of multiple segments of the superficial communicating veins.
On December 19, 2011, foam sclerotherapy was performed in an outpatient setting under ultrasound control using foam made of Fibro-Vein (sodium tetradecyl sulfate) 1% and 3%, using the Tessari method in an air to fibro-vein ratio of 4/1.
With the patient lying on his back with his legs raised at 30 degrees, the sclerosing agent was injected through intravenous catheters, after preliminary treatment of the injection sites with anesthetic cream. The sclerosed veins were covered with cotton flaps, which were fixed with bandages (Beha-haft), then class II compression stockings were put on.
Patient K. wore compression stockings around the clock for a month. The stockings were removed only during a medical examination once a week. (Before the examination, the patient was given the opportunity to take a shower).
The sclerosing course lasted a month, during which control examinations and dressings were carried out once a week. At the end of the course, follow-up examinations were carried out once every 2-3 weeks and, if necessary, until the ulcers were completely healed, which occurred 3.5 months after the start of treatment.
After recovery, the patient returned to an active life.
The course of treatment can last from 2 weeks to 3-4 months, depending on the area, depth, duration, infection of the ulcer, the age of the patient and concomitant diseases.
Conclusion
Foam ultrasound-guided sclerotherapy is a virtually safe, minimally invasive, highly effective method for treating varicose veins of the lower extremities and trophic ulcers of the legs of venous origin.