Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial

Manjit S Gohel, Jamie R Barwell, Maxine Taylor, Terry Chant, Chris Foy, Jonothan J Earnshaw, Brian P Heather, David C Mitchell, Mark R Whyman, Keith R Poskitt, Manjit S Gohel, Jamie R Barwell, Maxine Taylor, Terry Chant, Chris Foy, Jonothan J Earnshaw, Brian P Heather, David C Mitchell, Mark R Whyman, Keith R Poskitt

Abstract

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].