Impact of great saphenous vein ablation on healing and recurrence of venous leg ulcers in patients with post-thrombotic syndrome: A retrospective comparative study

Background: The optimal treatment approach for patients with active venous leg ulcers (VLUs) and post -thrombotic syndrome (PTS) associated with great saphenous vein (GSV) re fl ux remains unclear. To address this gap, we retrospectively compared the outcomes of patients with post -thrombotic VLU with an intact GSV vs those with a stripped or ablated GSV. Methods: We retrospectively analyzed data from 48 patients with active VLUs and documented PTS, who were treated at a single center between January 2018 and December 2022. Clinical information, including ulcer photographs, was recorded in a prospectively maintained digital database at the initial and follow-up visits. Two patient groups -group A (with an intact GSV) and group B (with a stripped or ablated GSV)-were compared in terms of time to complete healing, proportion of ulcers achieving complete healing, and ulcer recurrence during the follow-up period. Results: There were no signi fi cant differences in age, gender, initial ulcer size, or ulcer duration between the two groups. All included patients had femoropopliteal post -thrombotic changes. Group A had signi fi cantly more completely healed ulcers (33 of 34 ulcers, 97%) compared with group B (10 of 14 ulcers, 71%) ( P = .008). Group A also exhibited a signi fi cantly shorter time to complete ulcer healing (median: 42.5 days, interquartile range [IQR]: 65) compared with group B (median: 161 days, IQR: 530.5) ( P = .0177), with a greater probability of ulcer healing ( P = .0084). Long-term follow-up data were available for 45 of 48 patients (93.7%), with a mean duration of 39.6 months (range: 5.7-67.4 months). The proportion of ulcers that failed to heal or recurred during the follow-up period was signi fi cantly lower in group A (9 of 32 ulcers, 27%) compared with group B (11 of 13 ulcers, 85%) ( P = .0009). In addition, in a subgroup analysis, patients with an intact but re fl uxing GSV (12 of 34) had a signi fi cantly shorter time to heal (median: 34 days, IQR: 57.25) ( P = .0242), with a greater probability of ulcer healing ( P = .0091) and signi fi cantly fewer recurrences (2 of 12,16%) ( P = .006) compared with group B. Conclusions: Our fi ndings suggest that removal of the GSV through stripping or ablation in patients with postthrombotic deep venous systems affecting the femoropopliteal segment may result in delayed ulcer healing and increased ulcer recurrence. Patients with an intact GSV had better outcomes, even when the re fl uxing GSV was left untreated. These fi ndings emphasize the potential impact of GSV treatment on the management of VLUs in individuals with PTS. Further investigation is needed to validate these results and explore alternative therapeutic strategies to optimize outcomes for this patient population. (J Vasc Surg Venous Lymphat Disord 2024;12:101859.)