Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial

Gent, W.B. van; Catarinella, Fabio S.; Lam, Yee Lai; Nieman, Fred; Toonder, Irwin M.; Ham, Arie C. van der; Wittens, Cees H. A.

doi:10.1177/0268355514568848

Cited by 41 publications

(34 citation statements)

References 14 publications

(14 reference statements)

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“…At the time of publication of the systematic review7, the ESCHAR RCT21 reported substantially fewer recurrences after surgery at 4 years, whereas van Gent and co‐workers31 showed no difference in recurrence at 2 years. However, recently published long‐term follow‐up from the latter study showed that surgery almost halved the probability of recurrence at 10 years32, corroborating the outcome of the ESCHAR trial21. Nevertheless, these data should be interpreted cautiously.…”

Section: Discussionsupporting

confidence: 54%

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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BackgroundVenous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost‐effectiveness of interventional procedures alongside compression therapy versus compression therapy alone for the treatment of chronic venous leg ulceration.MethodsA Markov decision analytical model was developed. The main outcome measures were quality‐adjusted life‐years (QALYs) and lifetime costs per patient, from the perspective of the UK National Health Service at 2015 prices. Resource use included the initial procedures, compression therapy, primary care and outpatient consultations. The interventional procedures included superficial venous surgery, endothermal ablation and ultrasound‐guided foam sclerotherapy (UGFS). The study population was patients with a chronic venous ulcer who were eligible for either compression therapy or an interventional procedure. Data were obtained from systematic review and meta‐analysis of RCTs.ResultsSurgery gained 0·112 (95 per cent c.i. −0·011 to 0·213) QALYs compared with compression therapy alone, with a difference in lifetime costs of €−1330 (−3570 to 1262). Given the expected savings in community care, the procedure would pay for itself within 4 years. There was insufficient evidence regarding endothermal ablation and UGFS to draw conclusions.DiscussionThis modelling study found surgery to be more effective and less costly than compression therapy alone. Further RCT evidence is required for both endothermal ablation and UGFS.

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Section: Discussionsupporting

confidence: 54%

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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“…Even if their clinical meaning is still under debate [17][18][19], their closure in patients presenting with severe venous insufficiency, such as class C5 and C6 according to the CEAP classification, significantly contributes to better results of treatment [20][21][22][23][24][25][26][27][28]. Incompetence of perforating veins can be of primary or secondary nature.…”

Section: Discussionmentioning

confidence: 99%

Authors’ own method of diathermic thermal ablation of venous perforators – surgery with protective tumescence

Kuśnierczyk¹,

Nowakowski²

2016

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Objectives: Low-invasive endovenous thermal ablation techniques have become the preferred modality for the treatment of incompetent perforating veins. Material and methods:We managed 210 varicose-vein patients (268 limbs) presenting with coexisting superficial and perforator incompetence. We utilised bipolar radiofrequency ablation for the treatment of incompetent superficial veins and monopolar diathermal ablation under protective tumescence to manage incompetent perforators. To ablate incompetent perforating veins with monopolar diathermy we used a modified peripheral intravenous catheter with a long needle for administration of tumescence. Results: The success rate of thermal ablation of incompetent perforating veins, defined as completely occluded perforators demonstrated by Doppler sonography at one-year follow-up, was 95%. A similarly defined success rate of radiofrequency closure of incompetent superficial veins was 97%. There were no serious intraoperative complications such as deep vein thrombosis, peripheral nerve injuries, skin burns or persistent hyperpigmentations. There were transient hypoesthesias in 20% of patients presenting with incompetent Cockett I and Cockett II perforators. In addition, 96% of patients presenting with active ulcers had their ulcers healed 30-60 days after the procedure. Conclusions: Monopolar diathermy with the use of protective tumescence enables minimally invasive, effective, and precise ablation of incompetent perforators. This method is also safe, with no associated injury to adjacent anatomical structures or thromboembolic complications.

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“…Duplex scans can be used to identify venous obstruction and valvular incompetence 48 . It is therefore useful in recognising patients who may be suitable for endovenous procedures to abolish venous reflux and to reduce the risk of VLU recurrence 49,50 .…”

Section: Box 5 | Tips On Obtaining Abpimentioning

confidence: 99%

The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa

Bruwer

Botma²,

Mulder³

2020

Adv Skin Wound Care

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Many countries have published guidelines, which state that compression therapy is the 'gold standard' treatment for venous leg ulcers 1-11. Compression therapy is known to significantly increase VLU healing rates and reduce the risk of recurrence 12-13. Despite this, efforts to heal VLUs are often focused on the use of advanced wound dressings and other therapies, while an established key to healing-compression therapy-is underused. An international group of experts in leg ulcers and venous disease met in December 2014. The group recognised that a very high proportion of all leg ulcers have venous disease as a causative or contributory factor (i.e. are VLUs or mixed aetiology ulcers) and so may be appropriate for compression therapy. Their discussions centred on identifying how to encourage wider adoption of compression therapy by simplifying the key principles involved. The conclusions reached form the basis of this document and are presented as an ABC of the management of VLUs, with the focus on the active treatment phase. It is hoped that this simplified approach will help clinicians to clearly understand why, when and how compression therapy should be used. Everyone involved in wound healing should be ambitious in striving for a step change that decisively overturns passivity in expecting lengthy, delayed or non-healing of VLUs and other leg ulcers associated with venous disease. We need to actively seek to enhance affected patients' lives by improving healing rates through increased appropriate use of compression therapy.

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Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial

Cited by 41 publications

References 14 publications

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

Authors’ own method of diathermic thermal ablation of venous perforators – surgery with protective tumescence

The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa

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