Rossi et al [49] attests that compared with medial therapy alone, QoL and symptomatology are dramatically improved in both the short and long term with iliac vein stenting and medial therapy. A meta-analysis of available studies demonstrated that iliac vein stenting improved pain, swelling, and venous ulcer healing with secondary patency rates acceptable given relatively low overall risk [15]. Microphlebectomy There is no relevant literature regarding the use of microphlebectomy in the treatment of venous ulcers. Ligation and Stripping Higher rates of GSV reflux recurrence are identified with EVLA compared with high ligation and stripping. Both EVLA and high ligation and stripping, however, were noted to have similar metrics on disease specific QoL [37- 39]. Another study comparing high ligation and stripping versus EVLA in patients with GSV incompetence showed no significant difference between the 2 groups in recurrent GSV reflux, recurrent varicose veins, frequency of reoperations, Venous Clinical Severity Score, and QoL scores in a 5-year follow-up [40]. The RELACS study demonstrated, specifically, that high ligation and stripping was superior to EVLA in recurrence rates 5 years post- treatment [38]. Lower Extremity Chronic Venous Disease There are conflicting data regarding procedural complications. Pan et al [24] affirms that there is no significant difference in postprocedural phlebitis and bruising and concludes that there are fewer complications regarding bleeding, hematoma, wound infection, and paresthesia with EVLA. Rass et al [39], on the other hand, affirms that higher rates of phlebitis, tightness, and dyspigmentation were noted with EVLA. Wound Care Although literature has shown benefit in ulcer debridement in improving venous ulcer, the optimal protocol for wound care is yet to be elucidated. Beyond debridement, wound exudate control and surface bacteria management are additional important goals in wound care.
Lower Extremity Chronic Venous Disease. Rossi et al [49] attests that compared with medial therapy alone, QoL and symptomatology are dramatically improved in both the short and long term with iliac vein stenting and medial therapy. A meta-analysis of available studies demonstrated that iliac vein stenting improved pain, swelling, and venous ulcer healing with secondary patency rates acceptable given relatively low overall risk [15]. Microphlebectomy There is no relevant literature regarding the use of microphlebectomy in the treatment of venous ulcers. Ligation and Stripping Higher rates of GSV reflux recurrence are identified with EVLA compared with high ligation and stripping. Both EVLA and high ligation and stripping, however, were noted to have similar metrics on disease specific QoL [37- 39]. Another study comparing high ligation and stripping versus EVLA in patients with GSV incompetence showed no significant difference between the 2 groups in recurrent GSV reflux, recurrent varicose veins, frequency of reoperations, Venous Clinical Severity Score, and QoL scores in a 5-year follow-up [40]. The RELACS study demonstrated, specifically, that high ligation and stripping was superior to EVLA in recurrence rates 5 years post- treatment [38]. Lower Extremity Chronic Venous Disease There are conflicting data regarding procedural complications. Pan et al [24] affirms that there is no significant difference in postprocedural phlebitis and bruising and concludes that there are fewer complications regarding bleeding, hematoma, wound infection, and paresthesia with EVLA. Rass et al [39], on the other hand, affirms that higher rates of phlebitis, tightness, and dyspigmentation were noted with EVLA. Wound Care Although literature has shown benefit in ulcer debridement in improving venous ulcer, the optimal protocol for wound care is yet to be elucidated. Beyond debridement, wound exudate control and surface bacteria management are additional important goals in wound care.