Perforator Vein Reflux with Venous Ulcer When Conservative Therapy Has Not Achieved Healing
Clinical scenario
Adults with varicose veins of the lower extremities who have perforator vein reflux associated with one or more venous ulcers, and whose ulcer has not healed despite a prior course of conservative therapy.
Why this protocol is reached
A previous treatment line with conservative therapy — including compression therapy, comprehensive wound care, venotonic medications, and lifestyle modifications — did not achieve its primary goal: healing of the venous leg ulcer. This protocol defines the evidence-based next step.
Approach at this stage
This protocol introduces an ablative approach targeting the incompetent perforator veins, combined with continued conservative management. The complete sequencing, patient selection criteria, and supporting management steps are contained in the full protocol.
Clinical goals
Reduction in days to ulcer healing, increased rate of ulcer healing at 1 year, and improved venous clinical severity at 6 weeks.
References
DOI: 10.1016/j.jscai.2025.103729
- For patients with ulcer-associated perforator vein reflux, the SCAI guidelines panel suggests ablation therapy in addition to conservative management rather than conservative management alone (conditional recommendation, low certainty of evidence).
- If present, saphenous vein reflux should be ablated first.
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