Cardiovascular Journal of Africa: Vol 26 No 2 (March/April 2015)

55 / 67

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015 AFRICA e1
Case Report
Application of radiofrequency ablation procedure on a
morbidly obese patient with a venous ulcer and large
saphenous vein
, Özlem Yener, Hikmet Selçuk Gedik, Kemal Korkmaz, Turgut Özkan, Ayşe Lafçı, Kerim Çağ lı
Abstract
Venous ulcers that occur due to chronic venous insufficiency
are seen on the upper medial malleol of the ankle. Treatment
of venous ulcers is protracted and generally the success rate is
low. Co-morbid factors play an important role in the success
of treatment of venous ulcers. In this case report, we demon-
strate successful venous ulcer treatment in a morbidly obese
patient with co-morbid conditions.
Keywords: radiofrequency ablation, venous ulcer, chronic venous
deficiency
Submitted 6/5/13, accepted 20/10/14
Previously published online 16/3/15
Cardiovasc J Afr 2015; 26: e1–e2
DOI: 10.5830/CVJA-2014-065
Treatment of leg ulcers caused by chronic venous deficiency
(CVD) is a significant issue worldwide. Data from various studies
have shown the incidence of CVD-associated venous ulcer to be
in the range of 0.5 to 3%.1 Of this group, 1% of patients suffer
from ulcerative episodes at least once in their lives.
Venous ulcer is three times more prevalent in females than
males.2 Forty per cent of all ulcers are venous-related and their
prevalence increases with age. Venous ulcers are observed on
average in the sixth decade of life.2 They are present for more
than a year in more than half of the cases, and the ulcers recur
in about two-thirds of patients.2
Risk factors affecting the formation of venous ulcer are
advanced age, obesity [especially with body mass index (BMI)
above 30 kg/m2],3 hypertension, diabetes mellitus, congestive
heart failure, renal failure, low socio-economic level, lower-
extremity trauma, and venous thrombosis of more than a year’s
duration. As a result of these factors, lipodermatosclerosis
occurs and venous ulcers develop on the skin.
The main objective in the treatment of these patients is to
reduce venous pressure, decrease oedematous swelling, lower
the ulcer diameter, heal the ulcer, and prevent its recurrence. To
this end, tight compression stockings and surgical treatment are
recommended.4
Case report
Our case had had venous deficiency for about 14 years, with
venous ulcers occasionally recurring and then recovering. He
had venous deficiency according to a clinically, aetiologically
and anatomo-pathologically conducted classification (CEAP =
5) and had been using class II (32 mmHg) compression stockings
and venoprotective medicine for about three years. In addition,
our patient had co-morbid factors such as lymphoedema,
congestive heart failure (left ventricular ejection fraction in
echocardiography conducted in our hospital: 40%), hypertension
(he was using an angiotensin receptor antagonist and his blood
pressure was regulated), type 2 diabetes mellitus and morbid
obesity (174 kg, BMI: 60.2 kg/m 2).
The patient’s fasting blood glucose level was approximately
178 mg/dl (9.88 mmol/l) and HbA1c value was 7.3%. He also
had a history of smoking half a packet of cigarettes daily for
six years.
With a history of excision surgery for a varicose cluster twice
in the year 2000, the patient had high-output reflux throughout
the entire Valsalva in the bilateral sapheno-femoral junction,
which was revealed by Duplex ultrasonography. There was
no reflux present in the femoral and popliteal veins. The right
great saphoneous vein diameter was 12 mm, and the saphenous
diameter measured in the right leg’s sapheno-femoral junction
was 25.2 mm. The left great saphoneous vein diameter was
15 mm, and the saphenous diameter measured in the left leg’s
sapheno-femoral junction was 27.4 mm.
Department of Cardiovascular Surgery, Çanakkale Onsekiz
Mart University, Kepez, Çanakkale, Turkey
, MD,
Turgut Özkan, MD
Department of Radiology ,Turkiye Yuksek Ihtisas Education
and Research Hospital, Ankara,Turkey
Özlem Yener, MD
Department of Cardiovascular Surgery, Ankara Numune
Research and Education Hospital, Ankara, Turkey
Hikmet Selçuk Gedik, MD
Kemal Korkmaz, MD
Kerim Çağlı, MD
Department of Anesthesiology, Ankara Numune Research
and Education Hospital, Ankara, Turkey
Ayşe Lafçı, MD