Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial

Barwell, J.; Davies, Colin; Deacon, J.; Harvey, Kate; Minor, Julia; Sassano, Antonio; Taylor, M.; Usher, Jenny; Wakely, C.; Earnshaw, J. J.; Heather, B. P.; Mitchell, David C.; Whyman, M. R.; Poskitt, K. R.

doi:10.1016/s0140-6736(04)16353-8

Cited by 544 publications

(364 citation statements)

References 26 publications

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“…78 Five hundred patients with isolated superficial venous reflux and mixed superficial and deep reflux were randomised to either compression treatment alone or compression in combination with superficial venous surgery. Surgery did not improve ulcer healing rates but did significantly reduce 12 month recurrence rates after healing (12% versus 28%, hazard -2.76 (95% CI -1.78 to -4.27).…”

Section: Venous Surgerymentioning

confidence: 99%

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

Orr¹,

Klement²,

McCrossin³

et al. 2017

OWM

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++High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 -Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2 ++ High quality systematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal 2 -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, eg case reports, case series NHS Quality Improvement Scotland (NHS QIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation.SIGN guidelines are produced using a standard methodology that has been equality impact assessed to ensure that these equality aims are addressed in every guideline. This methodology is set out in the current version of SIGN 50, our guideline manual, which can be found at www.sign.ac.uk/guidelines/fulltext/50/index.html. The EQIA assessment of the manual can be seen at www.sign. ac.uk/pdf/sign50eqia.pdf. The full report in paper form and/or alternative format is available on request from the NHS QIS Equality and Diversity Officer.Every care is taken to ensure that this publication is correct in every detail at the time of publication. However, in the event of errors or omissions corrections will be published in the web version of this document, which is the definitive version at all times. This version can be found on our web site www.sign.ac.uk.This document is produced from elemental chlorine-free material and is sourced from sustainable forests.

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Section: Venous Surgerymentioning

confidence: 99%

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

Orr¹,

Klement²,

McCrossin³

et al. 2017

OWM

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“…Patients are usually elderly. In the ESCHAR study15, for example, the mean age was 73 (i.q.r. 60–80) years, and around 60 per cent of the patients were women.…”

Section: Methodsmentioning

confidence: 99%

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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“…61 Many studies including the Cochrane database demonstrated the beneficial effects of compression therapy on rate of ulcer healing and preventing of recurrence. 62,63 Unfortunately, for those who were non-compliant with compression therapy only 55% healed their VLU and the recurrence rate was close to 100% in 36 months. 64 For those who were compliant, the rate of healing was above 90% with a recurrence rate <20% in this meta-analysis.…”

Section: Compressionmentioning

confidence: 99%

“…As for recurrence, based on available evidence, surgery plus compression demonstrated higher statistical significance in ulcer prevention than compression alone. 62,72,73 Multiple RCTs consistently demonstrated that modern open surgery, radio frequency and laser ablation were equivalent in both effectiveness and safety in saphenous vein intervention. [74][75][76][77][78] Moreover, foam sclerotherapy was shown to be an effective saphenous ablative procedure but had a significantly higher recanalization rate on the treated saphenous segments compared to other ablative or surgical methods.…”

Section: Endovascular and Surgical Managementmentioning

confidence: 99%

Venous leg ulceration pathophysiology and evidence based treatment

Chi

Raffetto

2015

Vasc Med

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Venous leg ulceration (VLU) is one of the most predominate medical disorders worldwide and in the western hemisphere it affects around 1.5% of the general population and up to 5% of the elderly population. Unfortunately, this trend will only increase given the growth of an aging population worldwide. Understanding its pathophysiology that begins with venous hemodynamic abnormalities and leads to inflammatory alterations with microcirculatory changes is critical to delivering effective curative therapy. As such, the main component to treatment is reversing the underlying venous hypertension and pro-inflammatory milieu using compression treatment along with various adjuvant therapies. Given its impact, a comprehensive multi-pronged approach to care, treatment and prevention is required to reverse the increasing trend that is observed worldwide.

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Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial

Cited by 544 publications

References 26 publications

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

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

Venous leg ulceration pathophysiology and evidence based treatment

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