primary VVs develop in isolated segments of the superficial venous system (without connection to the deep system) at, or distal to, the underlying main trunk incompetence, suggesting a process of "spreading incompetence" from one focal point, producing varicosities (mainly in tributaries).

SFJ incompetence is associated with altered transcription of VEGF and its receptors reflecting an aetiological mechanism or later stage of disease development. Altered VEGF(121) and s.flt-1 transcription may be an early event in varicogenesis.

BACKGROUND Endovenous laser ablation and ultrasound-guided foam sclerotherapy are recommended alternatives to surgery for the treatment of primary varicose veins, but their long-term comparative effectiveness remains uncertain. METHODS In a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of laser ablation, foam sclerotherapy, and surgery. Primary outcomes at 5 years were disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants' treatment costs and scores on the EuroQol EQ-5D questionnaire. RESULTS Quality-of-life questionnaires were completed by 595 (75%) of the 798 trial participants. After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, −2.86; 95% confidence interval [CI], −4.49 to −1.22; P<0.001; and for surgery vs. foam sclerotherapy, −2.60; 95% CI, −3.99 to −1.22; P<0.001). Generic quality-oflife measures did not differ among treatment groups. At a threshold willingness-topay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation. In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery. CONCLUSIONS In a randomized trial of treatments for varicose veins, disease-specific quality of life 5 years after treatment was better after laser ablation or surgery than after foam sclerotherapy. The majority of the probabilistic cost-effectiveness model iterations favored laser ablation at a willingness-to-pay ratio of £20,000 ($28,433) per QALY.

Objective: A preliminary assessment of a novel device, the ‘wound boot’, in the management of leg ulcers. Procedures: Eight subjects with ulcers wore the boot for 5–14 days. Ulcers were cleaned with saline only. No other dressings were applied. Questionnaires examined comfort and ease of use and asked for suggestions for modifications. Additionally, nurses examined ‘time taken to clean and dress ulcers’ in comparison with standard dressings. Although not a primary end-point, ulcer healing was noted. Results: For all, the boot was comfortable, easy to use and preferable to standard dressings. Ulcer-associated odour was eliminated entirely. A significant reduction was seen in the nursing time taken to clean and dress ulcers. Occasionally, excess exudate was problematic, with the boot's absorptive materials insufficient. In two cases, where the ‘boot’ was applied for 14 days, significant wound healing was seen. Conclusions: The prototype ‘boot’ helped significantly in leg ulcer management. Modifications based upon this assessment will allow a second prototype to be evaluated fully.