Gohel MS, Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, Heather BP, Mitchell DC, Whyman MR, Poskitt KR, et al.
BMJ (Clinical research ed.). Date of publication 2007 Jul 14;volume 335(7610):83.
1. BMJ. 2007 Jul 14;335(7610):83. doi: 10.1136/bmj.39216.542442.BE. Epub 2007 Jun
1.
Long term results of compression therapy alone versus compression plus surgery
in chronic venous ulceration (ESCHAR): randomised controlled trial.
Gohel MS(1), Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, Heather BP,
Mitchell DC, Whyman MR, Poskitt KR.
Author information:
(1)Cheltenham General Hospital, Cheltenham, Gloucester GL53 7AN.
Comment in
BMJ. 2007 Jul 14;335(7610):55-6.
ACP J Club. 2007 Nov-Dec;147(3):73.
OBJECTIVE: To determine whether recurrence of leg ulcers may be prevented by
surgical correction of superficial venous reflux in addition to compression.
DESIGN: Randomised controlled trial.
SETTING: Specialist nurse led leg ulcer clinics in three UK vascular centres.
PARTICIPANTS: 500 patients (500 legs) with open or recently healed leg ulcers
and superficial venous reflux.
INTERVENTIONS: Compression alone or compression plus saphenous surgery.
MAIN OUTCOME MEASURES: 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).
CONCLUSION: 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.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN07549334
[controlled-trials.com].
DOI: 10.1136/bmj.39216.542442.BE
PMCID: PMC1914523
PMID: 17545185 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
