Early Venous Reflux Ulcer Trial
Conducted in the UK, the first global study on statistically significant samples of patients suffering from a venous ulcer has demonstrated the relevance of early surgery.
The study was presented by Alun Davies, EVRA chief investigator - Imperial College, London, United Kingdom, at the prestigious Charing Cross International Symposium held in April 2018. The outcome
When early surgery is practiced, this scientific evaluation reveals substantial improvements in terms of:
- accelerated healing,
- decrease in ulcer recurrence,
- overall reduction of costs related to surgery and nursing care.
For information, the treatment of venous ulcer represents 2% of the expenditure on health care in the United Kingdom.
We found it relevant to communicate about this study, insofar as the above conclusions are perfectly in line with the observation made for 2 years now by the TVC Medical team on the African continent.
With about ten cases in progress, both in terms of surgical intervention proper and nursing care, our recommendations are in all respects those of this study, performed on a larger sample.
The question raised is as follows: does surgery of the peripheral veins, when practiced in an early stage of the disease, contributes to a better healing process compared to the simple wearing of stockings, followed by deferred surgery if required. Statistical sampling covered 450 patients: - Sample 1: combined compression with surgery within two weeks - Sample 2: compression combined with delayed ablation ie after ulcer healing A significant difference could be observed in favor of early intervention, according to the following 3 criteria: - The speed of the healing process, with a 90% statistical confidence rate - The absence of ulcer recurrence. - The total cost, relative to the intervention as well as the nursing care, with a probability higher than 70%
In the treatment of venous ulcer, world-wide recommendations exist. These are mostly "2C" class, namely "This is our suggestion, but alternatives can be reasonably considered". As a reminder, here are the references of this classification: - https://www.uptodate.com/home/grading-guide - https://www.uptodate.com/contents/grade/6 Future recommendations Based on the results of this scientifically conducted study, the recommendations in force at the global level need to be reworked. Specifically: - The patient with a lower limb ulcer should be dispatched as soon as possible to a vascular specialist, for a critical evaluation of his vascular health - If the superficial venous incompetence is proven, the surgery is required without delay, as soon as possible Finally, it is essential that a budget be allocated to patient information and nurse training to support the above process. The study has indeed demonstrated the budgetary relevance, ie the ultimate reduction of the overall costs in health care, when this approach is followed. The presentation https://www.cxsymposium.com/evra-early-venous-reflux-ablation-ulcer-trial-presented-for-the-first-time-at-the-charing-cross-symposium/