Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial.
OBJECTIVE
To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression.


METHODS
Randomised controlled trial.


METHODS
Specialist nurse led leg ulcer clinics in three UK vascular centres.


METHODS
500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux.


METHODS
Compression alone or compression plus saphenous surgery.


METHODS
Primary outcomes were ulcer healing and ulcer recurrence. The secondary outcome was ulcer free time.


RESULTS
Ulcer healing rates at three years were 89% for the compression group and 93% for the compression plus surgery group (P=0.73, log rank test). Rates of ulcer recurrence at four years were 56% for the compression group and 31% for the compression plus surgery group (P<0.01). For patients with isolated superficial reflux, recurrence rates at four years were 51% for the compression group and 27% for the compress plus surgery group (P<0.01). For patients who had superficial with segmental deep reflux, recurrence rates at three years were 52% for the compression group and 24% for the compression plus surgery group (P=0.04). For patients with superficial and total deep reflux, recurrence rates at three years were 46% for the compression group and 32% for the compression plus surgery group (P=0.33). Patients in the compression plus surgery group experienced a greater proportion of ulcer free time after three years compared with patients in the compression group (78% v 71%; P=0.007, Mann-Whitney U test).


CONCLUSIONS
Surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time.


BACKGROUND
Current Controlled Trials ISRCTN07549334 [controlled-trials.com].
Gohel
Manjit S
MS
Cheltenham General Hospital, Cheltenham, Gloucester GL53 7AN.
Barwell
Jamie R
JR
Taylor
Maxine
M
Chant
Terry
T
Foy
Chris
C
Earnshaw
Jonothan J
JJ
Heather
Brian P
BP
Mitchell
David C
DC
Whyman
Mark R
MR
Poskitt
Keith R
KR
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D053828:Stockings, Compression; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000379:methods*; D014945:Wound Healing