Benefits of superficial venous intervention (surgery or endovenous ablation) in the treatment of venous leg ulceration

Venous leg ulceration is common, distressing for patients, and a major burden on healthcare services around the world. The mainstay of treatment is compression therapy, which has been shown to improve ulcer healing. Incompetence of superficial veins is common in patients with lower extremity wounds. The ESCHAR study showed that the traditional surgical approach for superficial reflux reduced venous ulcer recurrence. However, modern venous practice in most the United States and European centers has moved away from surgical stripping and endovenous interventions are now the first-line approach. These minimally invasive procedures may be more appropriate for the elderly and often frail population, who may not be fit or willing to undergo surgery under general anesthesia. The Early Venous Reflux Ablation (EVRA) study was designed to evaluate the role of early endovenous ablation in addition to compression therapy in the treatment of C6 disease. In this chapter, the design, clinical outcomes, and implementation challenges of the EVRA study are summarized.