Fast Healing of venous ulcers with Terminal, Axial and Perforator Interruption of the Reflux Source (TAPIRS-LF) with Laser- Foam and multilayer bandage

Introduction: The traditional surgical techniques are being replaced by minimally invasive procedures, such as Endovenous Laser (Thermal, Tumescent), and ultrasound foam sclerotherapy (Non-Thermal, Non-Tumescent). The aim of this study was to determine the healing time and rate of venous ulcers (VU) using a Terminal, Axial and Perforator Interruption of the Reflux Source (TAPIRS-LF) protocol. This included Endovascular Laser Treatment and endoluminal venous occlusion with ultrasound-guided foam and a multilayer bandage system until ulcer healing was achieved. Material and methods: A prospective non-controlled trial was conducted on patients with chronic venous leg ulcers (CEAP [clinical, etiological, anatomical and pathological elements] classification C6) during 2015 and 2016. A total of 27 patients aged 18 years and over, presenting with venous insufficiency, VU, and an ankle-brachial index greater than 0.8, were included, with a total of 27 extremities being analysed. All of the patients were subjected to thermal and non-thermal endoluminal occlusion, with endovenous laser treatment in axial venous system, with ultrasound-guided foam in the distal axial superficial venous system and perforator and terminal veins near to the ulcer, using the Tessari method with 3% polidocanol. Follow-up was carried out every week and a Doppler test was performed after 4, 12, and 24 weeks. Results: The mean age of the patients was 59.6 years. The active ulcer duration prior to treatment was 11.7 months. The mean VU diameter was 15.06 cm2, and 92.5% VU were seen to be healing at 8 weeks. Conclusions: The minimally invasive ablation using Terminal, Axial and Perforator Reflux with compression in patients with active VU results in a faster healing during the treatment of chronic venous ulcers.