DSA-guided versus ultrasound-guided foam sclerotherapy for venous leg ulcers: A retrospective comparative study

Objective To compare the short-term efficacy between DSA-guided and ultrasound-guided foam sclerotherapy (UGFS) for venous leg ulcers (VLUs). Methods We retrospectively analyzed patients with CEAP-C6 venous ulcers of the lower extremity admitted to a tertiary hospital between January 2021 and January 2024 who completed 12 months of follow-up. A total of 45 patients were included in the ultrasound-guided foam sclerotherapy group (US group) and 35 in the DSA-guided foam sclerotherapy group (DFS group). Ulcer healing time, dynamic healing rate, complications, and recurrence rate were compared between the two groups. Results The ulcer healing rates at 1 and 3 months after surgery were significantly higher in the DFS group than in the US group (80.0% vs 55.6%, P = 0.022; 91.4% vs 71.1%, P = 0.024). The DFS group also had a lower postoperative pain score [2 (1–3) versus 3 (2–4) P = 0.006]. The recurrence rate at 12 months showed a decreasing trend in the DFS group (11.4% vs 26.7%, P = 0.091). There were no significant differences in the incidences of superficial thrombophlebitis or pigmentation between the two groups, and the rate of skin necrosis was slightly lower in the DFS group (5.7% vs 8.9%). Conclusion Compared with ultrasound-guided foam sclerotherapy, DSA-guided foam sclerotherapy was associated with faster short-term ulcer healing, and lower postoperative pain in patients with venous leg ulcers. These preliminary findings suggest that DSA guidance may offer a potential advantage in improving the precision of sclerotherapy for lower extremity venous ulcers; however, these results require validation in prospective multicenter studies with larger sample sizes.