Venous leg ulcers heal faster and return less frequently in patients who have early surgery when compared with their peers who wear compression stockings and delay surgery, a new clinical trial has shown.
Venous leg ulcers can be caused by enlarged varicose veins that are common in older adults, especially women. The resulting sores may take months to heal. For five years, investigators followed outcomes in 450 patients who had early endovenous ablation, a minimally invasive surgical procedure, to close the enlarged veins. The surgery involves a small fiber that is inserted via a catheter to deliver bursts of heat to the vein, sealing it closed.
About half of the study participants were randomly assigned to receive the surgery within two weeks of study participation, followed by wearing compression stockings. The control group was given compression stockings (standard early care), but endovenous ablation treatment was delayed by six months or until the ulcer was healed.
The five-year follow-up showed that the rate of recurrent ulcers was 60% higher in the deferred intervention group. Wound healing time also was longer in this group, reported Manjit S. Gohel, M.D., of Cambridge University, Cambridge, England, and colleagues.
The research team, based in England, also found that early intervention was a less costly strategy on average over three years. Medicare in the United States and public healthcare in Britain typically take a deferred approach to surgical intervention for these ulcers.
The study was published in JAMA Surgery.
