TY - JOUR
T1 - Evidence for varicose vein surgery in venous leg ulceration
AU - Kheirelseid, Elrasheid A.H.
AU - Bashar, Khalid
AU - Aherne, Thomas
AU - Babiker, Thamir
AU - Naughton, Peter
AU - Moneley, Daragh
AU - Walsh, Stewart R.
AU - Leahy, Austin L.
N1 - Publisher Copyright:
© 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background Venous leg ulcers affect 1–3% of adults with a significant economic impact, utilizing 1% of annual healthcare budgets in some western European countries. Objectives To determine the effects of intervention for incompetent superficial veins on ulcer healing and recurrence in patients with active or healed venous ulcers. Search methods In October 2014, we searched Medline, CINAHL, EMBASE, Scopus, the Cochrane library and Web of Science without date or language restriction for relevant randomized or observational studies. Bibliographies of included studies were also searched for additional studies. Selection criteria Observational studies or randomized controlled trials comparing intervention for varicose veins with compression therapy alone for venous leg ulcers were eligible. In addition, studies compared open to endovenous therapy for varicose veins in patients with leg ulcers and those compared treating saphenous and perforating veins to treating saphenous veins only were also included. Studies had to report at least one ulcer-related outcome (healing rate, recurrence or time to healing). Data collection and analysis Details of potentially eligible studies were extracted and summarized using a data extraction table. Data extraction and quality assessment were performed independently by two review authors, and any disagreements resolved by consensus or by arbitration of a third author. Results Intervention for superficial venous reflux improved ulcer healing (risk ratio = 1.11 [1.00, 1.22], 95% CI, p = 0.04) and reduced recurrence (risk ratio = 0.48 [0.32, 0.67], 95% CI, p < 0.0001) compared to compression alone, with low level of evidence. Conclusion This review confirmed that the evidence for a beneficial effect of endovenous and open surgery for varicose vein in venous leg ulcer is at beast weak. A well-structured RCT is required to investigate the role of endovenous ablation of incompetent superficial veins in improving venous leg ulcer outcomes.
AB - Background Venous leg ulcers affect 1–3% of adults with a significant economic impact, utilizing 1% of annual healthcare budgets in some western European countries. Objectives To determine the effects of intervention for incompetent superficial veins on ulcer healing and recurrence in patients with active or healed venous ulcers. Search methods In October 2014, we searched Medline, CINAHL, EMBASE, Scopus, the Cochrane library and Web of Science without date or language restriction for relevant randomized or observational studies. Bibliographies of included studies were also searched for additional studies. Selection criteria Observational studies or randomized controlled trials comparing intervention for varicose veins with compression therapy alone for venous leg ulcers were eligible. In addition, studies compared open to endovenous therapy for varicose veins in patients with leg ulcers and those compared treating saphenous and perforating veins to treating saphenous veins only were also included. Studies had to report at least one ulcer-related outcome (healing rate, recurrence or time to healing). Data collection and analysis Details of potentially eligible studies were extracted and summarized using a data extraction table. Data extraction and quality assessment were performed independently by two review authors, and any disagreements resolved by consensus or by arbitration of a third author. Results Intervention for superficial venous reflux improved ulcer healing (risk ratio = 1.11 [1.00, 1.22], 95% CI, p = 0.04) and reduced recurrence (risk ratio = 0.48 [0.32, 0.67], 95% CI, p < 0.0001) compared to compression alone, with low level of evidence. Conclusion This review confirmed that the evidence for a beneficial effect of endovenous and open surgery for varicose vein in venous leg ulcer is at beast weak. A well-structured RCT is required to investigate the role of endovenous ablation of incompetent superficial veins in improving venous leg ulcer outcomes.
KW - Leg ulcers
KW - Varicose veins
KW - Venous ulcers
UR - https://www.scopus.com/pages/publications/84963579234
U2 - 10.1016/j.surge.2016.03.007
DO - 10.1016/j.surge.2016.03.007
M3 - Review article
SN - 1479-666X
VL - 14
SP - 219
EP - 233
JO - Surgeon
JF - Surgeon
IS - 4
ER -