Treating Venous Leg Ulcers

Treating Venous Leg Ulcers


Chronic venous insufficiency can affect the superficial venous network of the lower limbs, presenting as superficial venous reflux, which causes varicose veins, and venous leg ulcerations. Studies have shown that surgical correction of superficial venous reflux can reduce venous leg ulcer recurrence more than compression therapy alone. However, the role of endovenous treatment as an adjunct to compression therapy remains unclear. The Early Venous Reflux Ablation (EVRA) study was a multicenter, parallel-group, randomized trial of 450 patients with superficial venous reflux and venous leg ulcers. Patients were randomized to treatment of superficial venous reflux with compression therapy and either ‘early’ endovenous treatment, which entailed ablation within 2 weeks after randomization, or ‘deferred’ endovenous treatment, which
entailed ablation once the ulcer had healed or 6 months after randomization, if it had
not healed. The primary outcome, time to venous leg ulcer healing, was shorter in the early intervention group than in the deferred intervention group (a median of 56 days versus 82 days). The rate of ulcer recurrence among patients whose ulcers had healed within 1 year was 11.4% in the early intervention group as compared with 16.5% in the deferred intervention group. Disease-specific quality of life was similar
in the two groups at both 6 weeks and 6 months. The authors conclude that early endovenous intervention produced faster ulcer healing rates than deferred intervention for venous
leg ulcerations. Full trial results are available at NEJM.org

1 Comment

  1. Great video series. The bar graphs in this video are, however, very misleading. The deferred intervention bars should be over 40% higher than the early intervention, not the ~10% or less that is currently displayed. Regardless, thanks for these great resources!

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