Early Treatment for Leg Ulcers Leads to Better Patient Outcomes

Dawn O'Shea

October 06, 2020

Early surgical treatment of leg ulcers caused by varicose veins improves healing and reduces the risk of the condition coming back, according to the findings of the Early Venous Reflux Ablation randomised trial.

The study, led by researchers at Imperial College London and Imperial College Healthcare NHS Trust, included 450 patients with venous leg ulcers of less than 6 months duration and superficial venous reflux. A total of 426 of 450 participants from the vascular surgery departments of 20 UK hospitals were included in the analysis for ulcer recurrence.

Of the 426 participants whose leg ulcer had healed, 121 (28.4%) experienced at least one recurrence during follow-up. There was no clear difference in time to first ulcer recurrence between the two groups (HR, 0.82; 95% CI, 0.57-1.17; P=.28). Ulcers recurred at a lower rate of 0.11 per person-year in the early intervention group compared with 0.16 per person-year in the deferred intervention group (incidence rate ratio, 0.658; 95% CI, 0.480-0.898; P=.003).

Time to ulcer healing was shorter in the early intervention group for primary ulcers (HR, 1.36; 95% CI, 1.12-1.64; P=.002).

At three years, early intervention was 91.6 per cent likely to be cost-effective at a willingness to pay of £20,000 per quality-adjusted life year (QALY) and 90.8 per cent likely at a threshold of £35,000 per QALY.

Presenting the findings in  JAMA Surgery,  the authors say the study suggests that current guidelines should be revised to include early assessment of varicose veins and surgical treatment of leg ulcers to deliver clinical benefits and cost savings for the NHS. They suggest that this early treatment intervention could save the NHS an estimated £100 million per year.

Gohel MS, Mora MSc J, Szigeti M, Epstein DM, Heatley F, Bradbury A, Bulbulia R, Cullum N, Nyamekye I, Poskitt KR, Renton S, Warwick J, Davies AH; Early Venous Reflux Ablation Trial Group. Long-term Clinical and Cost-effectiveness of Early Endovenous Ablation in Venous Ulceration: A Randomized Clinical Trial. JAMA Surg. 2020 Sep 23 [Epub ahead of print]. doi: 10.1001/jamasurg.2020.3845. PMID: 32965493.  View full text

This article originally appeared on Univadis, part of the Medscape Professional Network.

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