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Early varicose vein treatment best for faster ulcer healing

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Treating venous leg ulcers by taking swift action to destroy or close faulty veins can significantly improve the chances of healing, according to a new study.

The research, led by Imperial College London, followed 450 patients with venous ulcers, which can lead to painful open sores and serious complications and cost the NHS millions each year.

“With this trial we have shown that by intervening early you improve the healing of the leg ulcer”

Alun Davies

The randomised controlled trial, which took place at 20 centres across the UK, saw half receive treatment within two weeks to tackle varicose veins, often the starting point for an ulcer.

Usually performed under a local anaesthetic, common treatments for varicose veins involve a surgeon destroying or closing the vein by injecting foam detergent, using a laser or heat to eradicate it, or sealing it with glue.

The remaining patients had treatment for varicose veins after their ulcer had healed or after six months, if the ulcer was still there.

All patients who took part in the trial, which was funded by the National Institute for Health Research, were asked to wear compression stockings and were tracked over a year.

Findings, published in the New England Journal of Medicine, show ulcers healed more quickly among those who received varicose vein treatment within two weeks.

Ulcers healed within an average of 56 days in this group, compared with 82 days among those whose treatment was delayed.

After 24 weeks, the healing rate was 85.6% in the group that got rapid treatment, compared with 76.3% in the control group.

“We need to find the most effective and cost-efficient method of treating this condition”

Francine Healey

Researchers said the results suggested many more people with venous ulcers would benefit from early intervention to tackle the underlying cause of the problem.

Lead author Professor Alun Davies, from the department of surgery and cancer at Imperial, said that currently many patients were not offered treatment for varicose veins.

“Leg ulcers can significantly impact on a patient’s quality of life and in severe cases can lead to someone losing part of their limb,” he said.

“They also represent a huge cost to the NHS,” he said. “However, at the moment, most patients are offered only compression stockings without being referred on for treatment that tackles root of the problem – the faulty vein.”

Until now he noted that there had been no robust research to assess whether treatments to close veins were effective or not when it came to sorting out venous ulcers.

“With this trial we have shown that by intervening early you improve the healing of the leg ulcer, and help a patient recover quicker,” he said.

He added: “We recommend that patients are referred to a vascular clinic upon diagnosis with a venous ulcer, to see if they would be suitable for early treatment.”

Imperial College London

Professor Alun Davies

Alun Davies

It is estimated the NHS deals with 731,000 leg ulcers each year and the majority of those are venous ulcers, which are more common in obese people and the elderly.

Some estimates put the annual cost to the health services of treating and managing leg ulcers at nearly £2bn.

The team behind this latest study said more research was needed into the problem of leg ulcers and the best treatment routes.

“As our population ages and obesity rises, leg ulcers look set to become an increasing issue for patients and the NHS,” said trial manager Francine Healey, also from Imperial.

“We need to find the most effective and cost-efficient method of treating this condition,” she said.

The team has done further analysis to show early treatment to tackle varicose veins is cost-effective with this work due to be published soon.

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