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

doi:10.1136/bmj.39216.542442.BE

BMJ 2007;335:83 (14 July), doi:10.1136/bmj.39216.542442.BE (published 1 June 2007)

Research

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

Manjit S Gohel, specialist registrar¹, Jamie R Barwell, consultant vascular and transplant surgeon², Maxine Taylor, leg ulcer nurse specialist¹, Terry Chant, vascular nurse specialist³, Chris Foy, medical statistician⁴, Jonothan J Earnshaw, consultant surgeon⁵, Brian P Heather, consultant surgeon⁵, David C Mitchell, consultant surgeon³, Mark R Whyman, consultant surgeon¹, Keith R Poskitt, consultant surgeon¹

¹ Cheltenham General Hospital, Cheltenham, Gloucester GL53 7AN, ² Derriford Hospital, Plymouth, ³ Southmead Hospital, Bristol, ⁴ Gloucestershire Hospitals NHS Trust, Gloucester, ⁵ Gloucestershire Royal Hospital, Gloucester

Correspondence to: K R Poskitt keith.poskitt{at}glos.nhs.uk

Objective To determine whether recurrence of leg ulcers maybe prevented by surgical correction of superficial venous refluxin addition to compression.

Design Randomised controlled trial.

Setting Specialist nurse led leg ulcer clinics in three UK vascularcentres.

Participants 500 patients (500 legs) with open or recently healedleg ulcers and superficial venous reflux.

Interventions Compression alone or compression plus saphenoussurgery.

Main outcome measures Primary outcomes were ulcer healing andulcer recurrence. The secondary outcome was ulcer free time.

Results Ulcer healing rates at three years were 89% for thecompression group and 93% for the compression plus surgery group(P=0.73, log rank test). Rates of ulcer recurrence at four yearswere 56% for the compression group and 31% for the compressionplus surgery group (P<0.01). For patients with isolated superficialreflux, recurrence rates at four years were 51% for the compressiongroup 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 compressiongroup and 24% for the compression plus surgery group (P=0.04).For patients with superficial and total deep reflux, recurrencerates at three years were 46% for the compression group and32% for the compression plus surgery group (P=0.33). Patientsin the compression plus surgery group experienced a greaterproportion of ulcer free time after three years compared withpatients in the compression group (78% v 71%; P=0.007, Mann-WhitneyU test).

Conclusion Surgical correction of superficial venous refluxin addition to compression bandaging does not improve ulcerhealing but reduces the recurrence of ulcers at four years andresults in a greater proportion of ulcer free time.

Trial registration Current Controlled Trials ISRCTN07549334 [controlled-trials.com] .

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