Endovenous thermal ablation for healing venous ulcers and preventing recurrence

Samuel, Nehemiah; Carradice, Daniel; Wallace, Tom; Smith, George E.; Chetter, Ian

doi:10.1002/14651858.cd009494.pub2

Cited by 37 publications

(35 citation statements)

References 44 publications

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“…We also compared these recommendations with the findings of the Cochrane research teams. [6][7][8][9][10] Note that while most guidelines recommended a particular therapy, a few did not mention the therapy or indicated that there was insufficient evidence on which to base a recommendation. For example, WHS, SVS-AVF, and SIGN recommended multi-compression bandages, but HAS made no direct recommendation for a type of pressure compression, and AWMA-NCWC indicated that there is minimal evidence to suggest that one type of compression is better than another.…”

mentioning

confidence: 99%

Comparison of guidelines for venous leg ulcer diagnosis and management

Clark

2016

Wound Repair Regeneration

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mentioning

confidence: 99%

Comparison of guidelines for venous leg ulcer diagnosis and management

Clark

2016

Wound Repair Regeneration

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“…Venous ulcers significantly impair quality of life, and their treatment places a heavy financial burden upon healthcare systems . Western healthcare systems spend around 1–3% of their budget in this area, and in the U.S.A. alone, treatment of venous ulcers costs around US$3 billion per year …”

Section: What Is Already Known About This Topic?mentioning

confidence: 99%

A randomized trial of early endovenous ablation in venous ulceration: a critical appraisal

Weiß¹,

Zeman²,

Schreml³

2018

Br J Dermatol

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Summary Aim Gohel et al. aimed to compare early endovenous ablation vs. deferred endovenous ablation of superficial venous reflux with regard to time to healing of venous leg ulcers, rate of healing at 24 weeks, recurrence rate, ulcer‐free time and health‐related quality of life. Setting and design This multicentre, parallel‐group (ratio 1 : 1), randomized controlled trial was conducted in a vascular surgery department setting at 20 participating centres across the U.K. Study exposure A total of 450 patients with venous leg ulcers were randomly assigned to receive compression therapy and undergo early endovenous ablation of superficial venous reflux within 2 weeks after randomization (early‐intervention group) or to receive compression therapy alone, with consideration of endovenous ablation deferred until after the ulcer was healed or until 6 months after randomization if the ulcer was unhealed (deferred‐intervention group). Outcomes The primary outcome was the time to ulcer healing. Secondary outcomes were the rate of ulcer healing at 24 weeks, the rate of ulcer recurrence, the length of time free from ulcers (ulcer‐free time) during the first year after randomization, and patient‐reported health‐related quality of life. Trial interventions Endovenous laser or radiofrequency ablation, ultrasound‐guided foam sclerotherapy, or nonthermal, nontumescent methods of treatment (such as cyanoacrylate glue or mechanochemical ablation) were performed either alone or in combination. The treating clinical team determined the method and strategy of endovenous treatment. Results The time to ulcer healing was shorter in the early‐intervention group than in the deferred‐intervention group. Furthermore, more patients had healed ulcers with early intervention [hazard ratio for ulcer healing 1·38, 95% confidence interval (CI) 1·13–1·68; P = 0·001]. The median time to ulcer healing was 56 days (95% CI 49–66) in the early‐intervention group and 82 days (95% CI 69–92) in the deferred‐intervention group. The rate of ulcer healing at 24 weeks was 85·6% in the early‐intervention group and 76·3% in the deferred‐intervention group. The median ulcer‐free time during the first year after trial enrolment was 306 days (interquartile range 240–328) in the early‐intervention group and 278 days (interquartile range 175–324) in the deferred‐intervention group (P = 0·002). The most common complications were pain and deep vein thrombosis (DVT) (early‐intervention group: pain, six of 28; DVT, nine of 28; deferred‐intervention group: pain, six of 24; DVT, three of 24). Conclusions Gohel et al. conclude that early endovenous ablation of superficial venous reflux results in faster healing of venous leg ulcers than deferred endovenous ablation. Patients assigned to the early‐intervention group also had longer ulcer‐free time during the first year after randomization.

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“…88 Although superficial endovenous thermal ablation is gaining in popularity, there are no randomized, controlled trials about its effects on healing VLUs, quality of life, or its cost effectiveness. 89 The evidence lacks robustness owing to large incompatibilities between the trials and different methods used to measure outcomes; therefore, more research is needed.…”

Section: Surgical Managementmentioning

confidence: 99%