Endovenous ablation plus compression aids healing of venous leg ulcers

Wednesday 30 August 2023

PEARLS No.

729

Clinical question

What are the effects of superficial endovenous ablation on the healing and recurrence of venous leg ulcers (VLUs)?

Bottom line

There is high-certainty evidence that endovenous ablation in combination with compression therapy is associated with reduced ulcer healing time when compared with compression alone or compression with deferred endovenous treatment.

In association with this, there is also moderate-certainty evidence suggesting that, when compared with compression alone or compression with deferred endovenous treatment, endovenous ablation in combination with compression therapy is probably associated with a higher number of ulcers healed at 90 days.

An economic analysis based on 1 study found moderate-certainty evidence demonstrating that endovenous ablation is probably a cost-effective treatment for VLUs at 1 year.

There is low-certainty evidence of unclear effects on recurrence and complications.

Caveat

The studies may be clinically skewed in favour of the control arm, as the healing rates in the control groups were much higher than those previously reported in real-world data, but this has the benefit of adding considerable confidence to the validity of the conclusions.

Most participants had an ulcer for less than 6 months. Further research is needed to explore the additional benefit of endovenous ablation in ulcers of greater than 6 months duration. This review did not find any studies which assessed the optimal modality of endovenous ablation.

Context

VLUs are a serious manifestation of chronic venous disease affecting up to 3% of the adult population. This typically recalcitrant and recurring condition significantly impairs quality of life, and its treatment places a heavy financial burden upon healthcare systems. The long-standing mainstay of treatment for VLUs is compression therapy. Surgical removal of incompetent veins reduces the risk of ulcer recurrence. However, open surgery is an unpopular option among people with VLUs, and many people are unsuitable for it.

The efficacy of the newer, minimally invasive endovenous techniques has been established in uncomplicated superficial venous disease, and these techniques can also be used in the management of VLUs. When used with compression, endovenous ablation aims to further reduce pressure in the veins of the leg, which may impact ulcer healing.

Cochrane Systematic Review

Cai PL, et al. Endovenous ablation for venous leg ulcers. Cochrane Database Syst Rev 2023;7:CD009494. This review contains 2 trials with a total of 506 participants.

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