The global management of leg ulceration: Pre early venous reflux ablation trial

Francine Heatley, Sarah Onida, Alun H Davies, Francine Heatley, Sarah Onida, Alun H Davies

Abstract

Background: Various guidelines exist worldwide for the diagnosis and management of venous leg ulcers; however, these are difficult to implement resulting in disparate treatment of patients globally.

Method: An online, 26-question survey was designed to evaluate the current global management of venous leg ulceration and was emailed globally to approximately 15,000 participants (November 2017-February 2018).

Results: Overall, 799 responses were received from 86 countries, with a 5% response rate. The respondent physicians saw a median of 10 (interquartile range 5-20) patients per month, with a median time to referral from primary to secondary care of six weeks. Of the respondents, 61% arranged an ankle brachial pressure index on first visit and 84% performed a venous duplex, with 95% prescribing compression for those in whom it was not contraindicated. Fifty-nine percent performed endovenous intervention or surgery prior to ulcer healing.

Conclusions: The survey showed a diversity of treatment pathways. The need to develop a robust, clear pathway for patients with leg ulceration is clearly required.

Keywords: Venous ulceration; chronic venous insufficiency; compression bandaging; endovenous treatment; leg ulcers.

Figures

Figure 1.
Figure 1.
Timing of endovenous or surgical interventions (n = 785).

References

    1. Posnett J, Gottrup F, Lundgren H, et al. The resource impact of wounds on health-care providers in Europe. J Wound Care 2009; 18: 154–161.
    1. Cullum N, Buckley H, Dumville J, et al. Wounds research for patient benefit: a 5-year programme of research Southampton (UK) . Southampton, UK: NIHR Journals Library, 2016.
    1. Graham ID, Harrison MB, Nelson EA, et al. Prevalence of lower-limb ulceration: a systematic review of prevalence studies. Adv Skin Wound Care 2003; 16: 305–316.
    1. Guest JF, Ayoub N, McIlwraith T, et al. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open Epub ahead of print 26 May 2015. DOI: 10.1136/bmjopen-2015-009283.
    1. Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. Phlebology 2008; 23: 103–111.
    1. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53: 2S–48S.
    1. Rice JB, Desai U, Cummings AK, et al. Burden of venous leg ulcers in the United States. J Med Econ 2014; 17: 347–356.
    1. Gonzalez-Consuegra RV, Verdu J. Quality of life in people with venous leg ulcers: an integrative review. J Adv Nurs 2011; 67: 926–944.
    1. Langer V. Quality-of-life with leg ulcers. Indian Dermatol Online J 2014; 5: 536–537.
    1. Lim CS, Gohel MS, Shepherd AC, et al. Secondary care treatment of patients with varicose veins in National Health Service England: at least how it appeared on a National Health Service website. Phlebology 2010; 25: 184–189.
    1. Marsden G, Perry M, Kelley K, et al. Diagnosis and management of varicose veins in the legs: summary of NICE guidance. BMJ 2013; 347: f4279.
    1. Bulbulia RA, Poskitt KR. The need for a National Service Framework for leg ulcers. Phlebology 2010; 25 (Suppl 1): 68–72.
    1. NICE. The diagnosis and management of varicose veins, (2013, accessed 10 June 2019).
    1. Gohel MS, Barwell JR, Taylor M, et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ 2007; 335: 83.
    1. O’Donnell TF JrandPassman MA.. Clinical practice guidelines of the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) – management of venous leg ulcers: introduction. J Vasc Surg 2014; 60: 1S–2S.
    1. Wittens C, Davies AH, Baekgaard N, et al. Editor’s choice – management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49: 678–737.
    1. Sheldon TA, Cullum N, Dawson D, et al. What’s the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients’ notes, and interviews. BMJ 2004; 329: 999.
    1. Davies HO, Popplewell M, Bate G, et al. Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service. Phlebology. 2018; 33: 84–88.
    1. Gohel MS, Heatley F, Liu X, et al. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med 2018; 378: 2105–2114.
    1. Authority HR. Health Research Authority decision tool, (2017, accessed 4 August 2017).
    1. Jensen MP. Questionnaire validation: a brief guide for readers of the research literature. Clin J Pain 2003; 19: 345–352.
    1. van der Velden SK, Pichot O, van den Bos RR, et al. Management strategies for patients with varicose veins (C2–C6): results of a worldwide survey. Eur J Vasc Endovasc Surg 2015; 49: 213–220.
    1. Tan MKH, Luo R, Onida S, et al. Venous leg ulcer clinical practice guidelines: what is AGREEd? Eur J Vasc Endovasc Surg 2019; 57: 121–129.
    1. Davies HO, Popplewell M, Bate G, et al. Publication of UK NICE Clinical Guidelines 168 has not significantly changed the management of leg ulcers in primary care: an analysis of The Health Improvement Network database. Phlebology 2019; 34: 311–316.
    1. Gohel MS, Taylor M, Earnshaw JJ, et al. Risk factors for delayed healing and recurrence of chronic venous leg ulcers – an analysis of 1324 legs. Eur J Vasc Endovasc Surg 2005; 29: 74–77.
    1. Davies HOB, Bradbury AW. The EVRA trial: new hope for people with venous leg ulcers? Eur J Vasc Endovasc Surg 2019; 57: 163–164.
    1. NICE CKS. NICE clinical knowledge summary – leg ulcer – venous, (accessed August 2015).
    1. Gohel MS, Barwell JR, Earnshaw JJ, et al. Randomized clinical trial of compression plus surgery versus compression alone in chronic venous ulceration (ESCHAR study) – haemodynamic and anatomical changes. Br J Surg 2005; 92: 291–297.
    1. Harkin DW, Beard JD, Shearman CP, et al. The vascular surgery workforce: a survey of consultant vascular surgeons in the UK, 2014. Eur J Vasc Endovasc Surg 2015; 49: 448–454.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する