ABSTRACT
Joel P. Harding, DO
Resident
University of California Davis
Sacramento, California, United States
Achieving healing of venous ulcerations can be time and labor intensive. The aim of this study was to evaluate the factors associated with conversion from open to healed venous ulcers in a large study cohort using the Vascular Quality Initiative Varicose Vein Registry.
Methods:
We performed a retrospective review using data from the Vascular Quality Initiative (VQI) Varicose Vein Registry from 2014 to 2018. We evaluated all varicose vein procedures performed for limb specific CEAP 6 venous disease. Demographic data was collected regarding patients as well as information about treatment modality. The primary outcome was complete healing of venous ulcers, identified by conversion from CEAP 6 to CEAP 5 disease. The secondary outcome was partial healing of venous stasis ulcers, identified as the reduction of the number of active ulcerations. Univariate and multivariate comparisons were performed as appropriate.
Results:
There were a total of 1089 procedures in 640 patients. The mean age was 61.1 (± 13.9) years and 42.7% were female patients. Patients were followed for a median of 102 (IQR 15-233) days. Patients who achieved complete wound healing did not differ from those who did not based on age, gender, body mass index, race, number of pregnancies, anticoagulation use, or treatment modality. However, patients that healed were less likely to have a prior history of phlebitis (4.4% versus 13.0%, p=0.002) and more likely to be utilizing compression at follow up (50.6% versus 39.8%, p=0.017). Patients with partial healing did not differ from those who did not have any healing based on age, gender, body mass index, race, anticoagulation usage or venous treatment modality. However, patients with partial healing had fewer pregnancies (mean 2.0 vs 2.6, p=0.02), had more veins treated during their procedure (mean 1.9 vs 1.7, p=0.01), and were more likely to be wearing compression on long term follow-up (48.3% versus 37.4%, p=0.01).
Conclusions:
Long term use of compression was associated with both complete wound healing and partial wound healing in patients that underwent venous interventions in the VQI Varicose Vein Registry. The mechanism of this relationship and the extent to which compression affects wound healing needs further elucidation.