Abstract
Dear Editor,
I read with interest the paper, “The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis” by Gábor Martis and Renáta Laczik. 1 I would like to congratulate the authors on bringing a very useful technique to the literature which mirrors, and greatly adds to, a presentation of our early results of a similar approach that we used to follow and that we presented at the UK Venous Forum in 2000. 2
However, we subsequently moved to a more conservative interventional approach by correcting underlying venous reflux in truncal veins using endovenous thermoablation and in perforating veins using the TRLOP technique. 3 Using these endovenous techniques, under local anaesthetic only since 2005, we have reported long-term healing of 85% in these C6 patients, 52% not needing any further compression at all.
Similar results have now been reported for endovenous foam sclerotherapy. 4
As the authors of this current study have shown 100% healing at one year with their radical surgery with long post-operative recovery, but simple endovenous techniques performed as ambulatory outpatient procedures as referenced above can show healing in 70 to 85% of the same sort of cases, do the authors think that their radical surgery should be reserved for those 15 to 30% of patients who fail the less invasive and less expensive endovenous techniques?
This would lead to a logical treatment strategy for patients with venous leg ulcers starting with minimally invasive ambulatory techniques for patients with reflux in their truncal veins and/or perforating veins, with radical surgery such as the authors described held in reserve for those patients failing this approach.