The results from the EVRA leg ulcer trial, published in the New England Journal on 31st May, were unveiled at TVS 2018 – The Conference on 25th April, 2018 in Newcastle.
Venous leg ulcers are open wounds or sores occurring on the lower legs of patients lasting for more than 2 to 4 weeks in duration. They are common, can cause pain and discomfort, affect the quality of life of those suffering from the condition. Veins in the legs contain valves which help move the blood upwards back to the heart again gravity, if these are damaged and do not work well the blood can flow downwards in the leg and pool near the ankles. This increases the pressure in the legs causing swelling, which can lead to skin damage and open ulcers.
Compression bandaging can help ulcers to heal by exerting an external pressure on the leg to mimic the action of the valves but this does not treat the underlying problem with the veins. Over the last 15 years or so, newer techniques (known as endovenous ablation) have been used to treat the veins and to help the ulcers heal.
The EVRA trial started in October 2013 and recruited 450 patients into this study from 20 hospitals across England. The study found that treating within two weeks with early endovenous ablation resulted in quicker ulcer healing and less time with the ulcers than using compression therapy alone and performing endovenous ablation only once the ulcer has healed. Treating ulcers early appears likely to be more cost effective (better use of NHS resources) than waiting until the ulcer has healed.