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Case Study/Series
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Venous ulcer healing; The predictive use of APG for saphenous ablation First Author: William J. Ennis D.O.,MBA,FACOS Authors: Aswath Subram MD, Patricio Meneses Ph.D. Chronic venous insufficiency represents a highly prevalent condition in the United States. Venous leg ulcers are the most common leg ulcer presenting to wound care centers representing up to 70% of cases. Despite their frequency,healing rates have been reported at only 65% at 24 weeks in a recent large randomized controlled clinical trial. Recurrence rates range from 45-70% in the literature. The wound care community has not embraced the CEAP classification system for venous ulcers and many wound studies lump all forms of venous insufficiency into one category when describing healing rates. Air plethysmography (APG), has been used by the authors to distinguish the venous hemodynamics, calf muscle pump function and to help predict which patients are candidates for saphenous ablation surgical techniqes.Sapehnous ablaltion has been proven,in a randomized controlled trial to reduce venous ulcer recurrence, but the wound care community has not embraced the technology. The authors report on the results of a previously conducted, non published, trial of 15 patients using APG to predict which patients had significant superficial reflux requiring ablation. This trial was conducted prior to CEAP classification and the more updated, computerized version of the APG machine. A recent, complicated venous ulcer patient will also be presented with pre and post operative APG readings (using a computerized APG device) which demonstrate the hemodynamic benefit of combining wound healing techniques with vein ablation in select cases. A review of the APG technology (including computer tracings), venous ulcer classification, and a proposed prospective venous ulcer trial will be reviewed in the poster. |
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