Superficial venous surgery plus compression reduced ulcer recurrence in chronic venous leg ulceration

摘要

Leg ulcers affect between 1.5-3.0 per 1000 people in the general population, and most are associated with venous disease.Furthermore, good evidence shows that multilayer, high compression bandaging is effective for promoting venous ulcer healing.2 However, compression therapy provides only a temporary solution and does not address the underlying problem of incompetent or non-functioning venous valves. Therefore, ulcer recurrence rates are high.The study by Barwell et al provides evidence that simple venous surgery may prevent venous ulcer recurrence. However, patients in this study were followed up for only 12 months, and longer term data are required. Similarly, surgery may be cost effective because leg ulcers are extremely costly to healthcare systems and patients alike; this hypothesis remains to be tested.This study will be of particular interest to nurses in primary care, who are either in a position to refer patients for specialist vascular assessment or seek referrals on behalf of patients. Specialist vascular services with Duplex scanning facilities are necessary to implement these findings, and their availability varies widely. Such detailed assessment of potentially eligible patients is important because the study found no significant effect of surgery on recurrence for the subgroup of patients with mixed superficial and total deep vein reflux, and these patients should not be offered surgery. Results of this study, the only randomised controlled trial of surgery for venous leg ulcers, are exciting, and we await longer term follow up data with interest.