Early Ablation Advantageous in Venous Ulceration

Early endovenous ablation of venous leg ulcerations and superficial venous reflux lead to better outcomes, according to a new study.

Researchers at Cambridge University Hospitals (United Kingdom), Imperial College London (Imperial; United Kingdom), and other institutions conducted a multi-center, randomized clinical trial involving 450 patients with venous leg ulceration (of less than six months’ duration) and superficial venous reflux. Patients were randomly assigned to early endovenous ablation (224 patients), or deferred endovenous treatment of superficial venous reflux (226 patients). The primary outcome was time to first ulcer recurrence and ulcer recurrence rate.

The results showed that of the 426 participants whose leg ulcer had healed, 28.4% experienced at least one recurrence during follow-up. There was no clear difference in time to first ulcer recurrence between the two groups, but the rate of recurrent ulcers was 60% higher in the deferred intervention group. In addition, the researchers also reported that healing times were shorter in the early intervention group, compared to the deferred intervention group. The study was published on September 23, 2020, in JAMA.

“Venous leg ulcers cause enormous physical and mental distress to patients, as well as having a financial impact on the National Health Service, which spends around two percent of its budget on managing lower limb wounds, and there is an urgent need to find more effective treatments,” said lead author Alun Davies, MD, of Imperial College London. “Our study is the first to show that early surgical treatment of leg ulcers leads to faster healing and the reduced risk of the ulcer coming back compared to current methods.”

Venous ulcers are the result of superficial venous reflux (also known as varicose veins), and tend to occur on the lower leg, just below the ankle to halfway up the calf. Venous ulcers may develop as a result of any injury to the leg or conditions such as varicose vein, a blood clot, multiple pregnancies, overweight, and standing for long periods of time, such as in work related situations. The ulcers are the result of pooling of fluid in the limb, and may include poor wound healing, edema, restricted mobility due to pain or discomfort when moving, and even amputation.


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Cambridge University Hospitals
Imperial College London