Leg Ulcer Outcomes

Francine Heatley, Manjit Gohel, Alun Davies
2021
Venous disease is the most common cause of leg ulceration. Treatment of superficial venous reflux has been shown to reduce the rate of ulcer recurrence but the effect of early endovenous ablation of superficial venous reflux on ulcer healing remains unclear. It is generally accepted that there is considerable global variation in the management of leg ulcers. Objectives To determine: the clinical and cost-effectiveness of early endovenous treatment of superficialvenous reflux in addition to
more » ... ard care compared to standard care alone in patients with venous ulceration; the current standards of global management of venous leg management and the impact on these following the results of the randomised controlled trial. Methods i. The Early Venous Reflux Ablation Trial (EVRA) multi-centre randomised clinical trial of 450 participants compared early versus deferred intervention at 12 months and at 3.5 years. ii. Health professionals treating patients with leg ulcers globally were surveyed before and after the publication of the RCT results to gain insight on the management of venous leg ulceration, and subsequent impact on practice. Results i. EVRA: i. time to ulcer healing was shorter in the early group at 12 months; no clear difference in time to first ulcer recurrence at 3.5 years; early intervention at 3 years is 91% likely to be cost-effective at £20,000/QALY. ii. Surveys: ⁃ Pre/post-EVRA UK primary care: 90/643 responses received; Pre/post-EVRA global clinicians: 799/644 responses were received. Conclusions The EVRA RCT showed that early intervention reduces the time to healing of venous leg ulcers, does not affect the time to recurrent ulceration but is highly likely to be cost-effective and therefore is beneficial for both patients and healthcare providers. The surveys demonstrated that the management of venous ulceration is disparate globally. It is likely that the EVRA RCT results influenced the timing of intervention worldwide.
doi:10.25560/91058 fatcat:u2zqb4ey3bdwfm6sfetq4ft5v4