Surgical Treatment of Severe Chronic Venous Disease: An Overview of Results and Clinical Considerations. Hospital Nacional De Itauguá- Paraguay (2021-2023)

Of 95 patients, the average age at presentation was 55 years. Eighty-eight percent were female. Of the patients, 95.6% were diabetic and hypertensive.  69.3% had incompetence of the FSU with insufficiency of at least one perforator. 65.3% of the patients were treated with conventional open surgery for the treatment of venous reflux. 85% presented an ulcer smaller than 5 cm, located in the internal malleolus (77%) with an evolution of less than 1 year (62%). The 83.15% had complete healing at the third postoperative month, of which the majority healed with high arch ligation, perforator ligation and epifascial phlebectomy (RR = 0.16 [0.04- 0.55], 95 % CI, p = 0.0049).  A small proportion of those treated with ultrasound-guided sclerotherapy did not achieve complete healing. There is a statistically significant relationship between complete healing at the third month of smaller ulcers with respect to those of smaller size (RR = 0.12 [0.01- 0.66], 95 % CI, p = 0.00061. RR = 2.22 [0.38- 1.61], 95 % CI, p = 0.22 respectively).

Conclusions:

Surgical treatment of venous ulcers offers a viable option for selected patients, aiding healing and reducing the burden of disease. In developing countries, where endovascular therapy is not available in public care, early conventional surgery cannot be ruled out to benefit these patients as it has proven its efficacy over time by providing healing effectiveness at lower costs.