Challenges in the reflux ablation in a patient with chronic venous leg ulcer – case report

Introduction
Venous leg ulcer is a severe health problem for patients with a long history of venous hypertension. The treatment includes invasive procedures including both surgical removal of insufficient veins and their intravenous ablation. The latter technique, although often used especially in patients with refractory or recurrent ulceration, sometimes encounters difficulties that reduce the chances of its success.

Material and methods
In a patient with a 30-year history of venous ulceration due to insufficient saphenous vein, intravenous laser ablation was performed due to the inability to heal the ulcer for a long time with various forms of conservative treatment.

Results
Within a few weeks of the surgery, the venous ulcer was effectively healed. After 8 months, recanalization of the proximal section of the great saphenous vein, connecting with the varicose veins of the thigh, leg and venous plexuses in the area of the ulcer, was found, but without the accompanying opening of the wound. Despite the constant use of compression therapy by the patient, about a year after the procedure, the ulcer reopened. Next, sclerotherapy of the insufficient great saphenous vein trunk as well as varicose veins was performed, resulting in the wound healing again.

Conclusions
The procedure of intravenous ablation of insufficient venous trunks is an effective form of venous ulcer treatment. However, in order to maintain a long-term positive effect of treatment, it is advisable to eliminate all sources of venous insufficiency as early as possible and carefully monitor the patient at all stages of therapy.