By Tina Allen
Early treatment of superficial venous reflux (varicose veins) using endovenous ablation combined with compression therapy results in a significantly faster healing time of leg ulcers and more ulcer-free days than compression therapy alone and deferred treatment, a UK trial has concluded.
The randomised trial of 450 patients (mean age, 68 years) with venous leg ulcers in 20 centres, published in The New England Journal of Medicine, showed only a 9.3% increased rate of ulcer healing at 24 weeks for patients treated within two weeks of trial entry (85.6%) compared with a deferred intervention group (76.3%). However, trial showed that the median time to ulcer healing was significantly faster in the early intervention group than in the deferred group (56 vs 82 days, respectively).
In the deferred group, endovenous ablation was not performed until after the ulcer had healed or at six months if the ulcer remained unhealed.
Conjoint Associate Professor at the Faculty of Health, Newcastle University, Paul Myers told Cardiology Today that optimal-grade compression hosiery was necessary to heal venous leg ulcers but did not treat the underlying pathology that allowed ulcers to occur and recur after minor trauma.
‘This study, although of small numbers, confirms the effectiveness of compression hosiery and the strategy used by vascular surgeons worldwide to treat the underlying venous insufficiency quickly, if possible,’ Associate Professor Myers said.
He noted that although ulcers might heal with compression therapy, they would almost inevitably recur without endovenous ablation; a point that the trial did not address and would take difficult studies to prove statistically.
The trial authors said the good healing rates in both treatment groups might be because all subjects were provided with high-quality compression therapy, which was not common outside of randomised trials.
Associate Professor Myers said appropriate grade compression hosiery was difficult to both put on and remove, so many elderly patients were unable to do this without help.
‘Compliance is therefore a very real issue in attaining optimal ulcer healing, especially in rural areas of Australia where there are fewer community nurses, but it is unequivocal that compression therapy is needed,’ he said.
NEJM 2018; doi: 10.1056/NEJMoa1801214.