The ESCHAR trial: should it change practice?
BACKGROUND
Most leg ulcers are caused by venous disease, the most common cause of venous hypertension being superficial vein incompetence. The ESCHAR trial tested the value of superficial vein surgery combined with compression in the healing and recurrence of venous leg ulcers compared with compression alone.


METHODS
A total of 500 patients with chronic venous leg ulcers, or recently healed ulcers, were randomized to superficial vein surgery and compression or compression alone. Vein surgery was saphenofemoral ligation and great saphenous stripping and phlebectomy or saphenopopliteal ligation and phlebectomy.


RESULTS
Ulcer healing was virtually identical between the 2 groups at 65% at 24 weeks; subgroup analysis failed to show a benefit for surgery to promote ulcer healing. Ulcer recurrence rate was halved in those that underwent surgery regardless of the presence of deep vein incompetence.


CONCLUSIONS
Superficial vein surgery should be considered in all leg ulcer sufferers to reduce ulcer recurrence rather than accelerate ulcer healing.
Wright
David D I
DD
BTG International Limited, London, United Kingdom. david.wright@btgplc.com
D002908:Chronic Disease; D003131:Combined Modality Therapy; D005268:Femoral Vein / Q000601:surgery; D006801:Humans; D007871:Leg Ulcer / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008026:Ligation; D015337:Multicenter Studies as Topic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012501:Saphenous Vein / Q000601:surgery; D055502:Secondary Prevention; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D014690:Venous Pressure; D014945:Wound Healing