New technique to heal venous ulcers: terminal interruption of the reflux source (TIRS)

Abstract

Background: Treatment of healing venous ulcers continues to be a challenge; currently used techniques, as adjuncts to compression therapy aid to prevent recurrence but fail to heal ulcers.

Method: A technique of terminal interruption of the reflux source (TIRS) was used. The TIRS procedure targets the terminal source of reflux. The purpose of the procedure is to temporarily reduce the venous hypertension at the local level, thus allowing healing to occur. By ultrasound guidance, 1% Sotradecol foam is injected into a venous branch or branches in close proximity to the ulcer bed. The branch may course under the ulcer or lead directly to it. Although more than one outflow source may be localized, all targeted veins must have documentation of reflux and have continuity with the primary source.

Results: To date, 14 patients have been treated. All had long-standing ulcers, 6 months to 2 years, and had been compliant with compression therapy. All patients were CEAP (clinical, etiologic, anatomic, pathophysiologic) class 6 with a venous clinical severity score ranging from 12 to 22. Rapid healing of all venous ulcers with an average time to ulcer healing of 6 to 8 weeks has been achieved. In all, 7 patients are ulcer free at 5 years, 4 patients are ulcer free for more than 2 years, 2 patients are ulcer free at 1 year, and 1 patient is undergoing treatment on remaining ulcers.

Conclusion: TIRS is a safe and effective treatment to heal venous ulcers. Local reduction of venous hypertension is the underlying factor for promoting rapid healing. More studies and careful documentation will likely prove the validity of this treatment regime.