Systematic review and meta-analysis of surgical interventions versus conservative therapy for venous ulcers.
OBJECTIVE
This goal of this study was to systematically review the literature to determine if surgical intervention (open or endovascular) is superior to compression alone with respect to ulcer healing, ulcer recurrence, and time to ulcer healing in patients with lower extremity venous ulcer disease.


METHODS
We conducted a comprehensive search of multiple databases for randomized controlled trials (RCTs) and comparative observational studies from 1990 to December 2013. The interventions of interest were any open or endovascular surgical interventions on the venous system in the lower extremity compared with compression alone.


RESULTS
We included 11 studies (seven RCTs and four observational studies) with moderate to increased risk of bias. The meta-analysis of all studies demonstrated increased healing rate (pooled risk ratio [RR], 1.06; 95% confidence interval [CI], 1.00-1.13; I(2) = 10%) and lower risk of recurrence (RR, 0.54; 95% CI, 0.34-0.85; I(2) = 27%) with open surgical procedures compared with compression. However, the meta-analysis of only RCTs showed no difference, possibly due to imprecision. The meta-analysis of three RCTs showed no difference in time to ulcer healing, -0.41 (95% CI, -0.89 to 0.07). Two studies of endovascular surgical procedures compared with compression showed no significant difference in ulcer healing (RR, 1.65; 95% CI, 0.43-6.32). One study of open surgical venous ligation and stripping compared with endovenous laser also showed no significant difference in ulcer recurrence (RR, 0.83; 95% CI, 0.21-3.27).


CONCLUSIONS
Open surgical interventions may improve lower extremity venous ulcer healing. The quality of this evidence is low because the analysis was dominated by the results of observational studies. The current evidence does not definitively support the superiority of endovascular surgical interventions compared with compression alone.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Mayo Clinic, Rochester, Minn.
Karen F
KF
Mauck
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
Noor
N
Asi
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
Chaitanya
C
Undavalli
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
Tarig A
TA
Elraiyah
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
Mohammed
M
Nabhan
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
Osama
O
Altayar
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn.
Mohamad Bassam
MB
Sonbol
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
Larry J
LJ
Prokop
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
Mohammad Hassan
MH
Murad
D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D058128:Compression Bandages / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D016017:Odds Ratio; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000175:diagnosis / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014945:Wound Healing / Q000187:drug effects*
D002317:Cardiovascular Agents