Comparative Study of Venous Ulcer Healing with Conventional Saphenofemoral Junction Ligation and Great Saphenous Vein Stripping Alone versus Combined with Foam Sclerotherapy of Pathological Perforators
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Keywords
Sclerotherapy, Saphenous Vein, Varicose Ulcer, Venous Insufficiency
Abstract
Background: Venous leg ulcers represent an advanced manifestation of chronic venous disease and are associated with delayed healing and substantial morbidity. Persistent pathological perforator reflux may contribute to sustained venous hypertension and impaired ulcer healing despite treatment of superficial venous reflux.
Objective: To compare venous ulcer healing following conventional saphenofemoral junction (SFJ) ligation and great saphenous vein (GSV) stripping alone versus the same procedure combined with ultrasound-guided foam sclerotherapy of pathological perforators.
Methods: This prospective comparative study included 80 adults with active venous leg ulcers (CEAP C6) and duplex-confirmed SFJ/GSV reflux with pathological perforators at a tertiary care hospital from July 2024 to April 2025. Patients were equally allocated to Group A (n=40), undergoing SFJ ligation with GSV stripping alone, and Group B (n=40), receiving the same procedure combined with ultrasound-guided sodium tetradecyl sulfate foam sclerotherapy of pathological perforators. Standardized postoperative wound care and compression therapy were provided to both groups. The primary outcome was complete ulcer healing within 12 weeks; secondary outcomes included healing time, percentage reduction in ulcer area, Venous Clinical Severity Score (VCSS), and complications. Data were analyzed using appropriate comparative tests, Kaplan–Meier analysis, and Cox proportional-hazards regression, with p<0.05 considered statistically significant.
Results: The mean age was 49.7±10.9 years, and 45 (56.3%) patients were male. Baseline characteristics were comparable between groups. Complete ulcer healing at 12 weeks was significantly higher in Group B than Group A (77.5% vs 55.0%; p=0.033; RR 1.41, 95% CI: 1.02–1.95). Median healing time was shorter in Group B (8.4 vs 10.8 weeks; log-rank p=0.018). Group B showed a greater reduction in ulcer area (88.9±16.4% vs 74.6±22.7%; p=0.002) and a lower 12-week VCSS (4.9±1.8 vs 7.2±2.4; p<0.001). Combined treatment remained independently associated with faster healing (adjusted HR 1.86, 95% CI: 1.10–3.15; p=0.021), without a significant increase in serious complications.
Conclusion: Adding ultrasound-guided foam sclerotherapy of pathological perforators to conventional SFJ ligation and GSV stripping improved 12-week ulcer healing, shortened healing time, and produced greater reductions in ulcer area and clinical severity without increasing serious complications.
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