Perforator Vein Injection for Symptomatic Venous Disease

NCT ID: NCT03363633

Last Updated: 2018-02-23

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: NA
• Total Enrollment: 12 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-03-31
• Study Completion Date: 2010-10-01

Brief Summary

The primary objective of this study is to compare two treatment strategies for symptomatic venous stasis disease with and without venous ulcer. These treatments are compression therapy alone vs. sclerotherapy of refluxing perforating veins with compression.

Detailed Description

Symptomatic venous disease is a widespread problem, affecting millions of patients per year, an estimated 1.0 - 1.5% of the population. This costs up to 1% of the total health care budget1-3. Venous problems account for almost 3000 patient visits in the UPP vascular surgery group per year. Although great progress has been made in venous stasis treatments there are still patients who suffer for many years with pain and ulceration due to venous disease. The investigators believe that venous hypertension is the underlying cause of venous ulceration. Three mechanisms leading to venous hypertension are well-recognized: superficial vein (great, accessory and small saphenous) incompetence; deep vein (common and superficial femoral, popliteal and tibial) reflux or obstruction; perforating vein incompetence. Patients with venous stasis and ulceration may have any or all of these conditions. Currently there are excellent treatments for superficial venous reflux, namely laser or radiofrequency ablation. Deep venous reflux therapy is still under investigation, with prosthetic valves in trial. However, compression is still the mainstay of therapy. The presence of deep venous reflux has been shown to have a significant effect on ulcer healing when perforator treatment has been investigated4. Refluxing perforator vein treatment is currently in flux, with the existing options of open surgery and subfascial endoscopic perforator surgery (SEPS) being the most tested options, but with significant wound complications and long hospital stays associated with both7. The investigators are proposing a prospective trial to evaluate percutaneous perforator thrombosis to achieve similar results with less morbidity.

The population targeted is patients with venous stasis or ulceration who either do not have demonstrable superficial reflux amenable to ablation, or have venous symptoms and ulceration despite treatment of incompetent superficial veins. When patients have refluxing perforating veins, there is debate on optimal treatment. Open and endoscopic ligation and compression therapy have all been tried with varying degrees of success and morbidity. The average rate of healing in venous ulcers is approximately .05 cm/wk 5,6, which has been shown to significantly improve after perforator ligation4, but with high morbidity. Ultrasound-guided injection of perforating veins is now performed, but with largely unknown benefits and consequences. The investigators propose a prospective, randomized trial of perforator injection with sodium tetradecyl sulfate (STS) foam vs. compression as a means of determining the efficacy and morbidity of perforator STS foam injection for symptomatic venous disease. The investigators currently utilize both methods of treatment in practice. Injections and compression or compression alone are chosen based on each patient's clinical scenario. STS is currently approved by the U.S. Food and Drug Administration for intravenous use.

Conditions

Venous Disease

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Observation

Group Type: NO_INTERVENTION

No interventions assigned to this group

Injection + Compression

Group Type: EXPERIMENTAL

sodium tetradecyl sulfate

Intervention Type: DRUG

Ultrasound-guided injection with sodium tetradecyl sulfate foam of refluxing perforating veins

Compression

Intervention Type: DEVICE

20-30 mmHg compression stockings

Compression

Group Type: ACTIVE_COMPARATOR

Compression

Intervention Type: DEVICE

20-30 mmHg compression stockings

Interventions

sodium tetradecyl sulfate

Ultrasound-guided injection with sodium tetradecyl sulfate foam of refluxing perforating veins

Intervention Type: DRUG

Compression

20-30 mmHg compression stockings

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• • The subject must be > 18 years of age, male or female

• Subject must be willing and able to wear compression stockings
• Subject must have refluxing perforating veins ≥ 3.0 mm in diameter at the calf level or distally in the affected leg.
• Subject presents with ulceration or other symptoms of venous stasis including:

rash, swelling, pain, bleeding, recurrent cellulitis

• The subject must sign a written informed consent, prior to randomization, using a form that is approved by the local Institutional Review Board.

Exclusion Criteria

• • Pregnancy

• Known allergy to STS
• Refusal to wear compression stocking
• Untreated significant great or small saphenous reflux
• Disseminated malignancy or other terminal condition where subject is expected to live less than 6 months.
• Significant arterial disease (ABI < .8)
• Buergers disease
• Acute superficial thrombophlebitis
• Phlebitis migrans
• Acute cellulitis
• Clinical evidence of active local or systemic infection

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 100 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

American College of Phlebology

OTHER

Sponsor Role: collaborator

Ellen Dillavou

OTHER

Sponsor Role: lead

Responsible Party

Ellen Dillavou

Associate Professor

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Ellen D Dillavou, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

Shadyside Medical Building, Suite 307

Pittsburgh, Pennsylvania, United States

Countries

United States

References

Cai PL, Hitchman LH, Mohamed AH, Smith GE, Chetter I, Carradice D. Endovenous ablation for venous leg ulcers. Cochrane Database Syst Rev. 2023 Jul 27;7(7):CD009494. doi: 10.1002/14651858.CD009494.pub3.

Reference Type: DERIVED

PMID: 37497816 (View on PubMed)

Other Identifiers

Protocol #4

Identifier Type: -

Identifier Source: org_study_id