A prospective evaluation of the outcome after small saphenous varicose vein surgery with one-year follow-up.

OBJECTIVE: The aim was to examine the effect of various surgical maneuvers during standard surgery for small saphenous varicose veins (SSV). METHODS: This was a prospective cohort study of patients that underwent small saphenous varicose vein surgery. Two-hundred nineteen consecutive patients (234 legs) with isolated primary or recurrent small saphenous varicose veins undergoing surgery were enrolled in a multicenter study involving nine vascular centers in the United Kingdom. Operative technique was determined by individual surgeon preference; clinical and operative details, including the use of stripping, were recorded. Clinical examination (recurrence rates) and duplex imaging (superficial and deep incompetence) were evaluated at six weeks and one year after surgery. RESULTS: A total of 204 legs were reviewed at one year; 67 had small saphenous varicose vein stripping, 116 had saphenopopliteal junction (SPJ) disconnection only, and the remainder had miscellaneous procedures. The incidence of visible recurrent varicosities at one year was lower after SSV stripping (12 of 67, 18%) than after disconnection only (28 of 116, 24%), although this did not reach statistical significance. There was no significant difference in the rate of numbness at one year between those who had SSV stripping (20 of 71, 28%) and those who had disconnection only (38 of 134, 28%). The rate of SPJ incompetence detected by duplex at one year was significantly lower in patients who underwent SSV stripping (9 of 67, 13%) than in those who did not (37 of 115, 32%) (P < .01). CONCLUSION: Stripping of the SSV significantly reduced the rate of SPJ incompetence after one year without increasing the rate of complications.

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

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].

Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial.

BACKGROUND: Chronic venous leg ulceration can be managed by compression treatment, elevation of the leg, and exercise. The addition of ablative superficial venous surgery to this strategy has not been shown to affect ulcer healing, but does reduce ulcer recurrence. We aimed to assess healing and recurrence rates after treatment with compression with or without surgery in people with leg ulceration. METHODS: We did venous duplex imaging of ulcerated or recently healed legs in 500 consecutive patients from three centres. We randomly allocated those with isolated superficial venous reflux and mixed superficial and deep reflux either compression treatment alone or in combination with superficial venous surgery. Compression consisted of multilayer compression bandaging every week until healing then class 2 below-knee stockings. Primary endpoints were 24-week healing rates and 12-month recurrence rates. Analysis was by intention to treat. FINDINGS: 40 patients were lost to follow-up and were censored. Overall 24-week healing rates were similar in the compression and surgery and compression alone groups (65% vs 65%, hazard 0.84 [95% CI 0.77 to 1.24]; p=0.85) but 12-month ulcer recurrence rates were significantly reduced in the compression and surgery group (12% vs 28%, hazard -2.76 [95% CI -1.78 to -4.27]; p<0.0001). Adverse events were minimal and about equal in each group. INTERPRETATION: Surgical correction of superficial venous reflux reduces 12-month ulcer recurrence. Most patients with chronic venous ulceration will benefit from the addition of simple venous surgery.