- Publication # 14-RA004
Treatment approaches for chronic venous ulcers reviewed
Comparative Effectiveness Research
There is a general lack of conclusive evidence on the benefits and harms of advanced wound dressings, systemic antibiotics, and surgical interventions in the treatment of venous leg ulcers lasting six or more weeks in patients with preexisting venous disease, according to a new AHRQ review of the topic. However, certain conclusions can be drawn from this research.
According to the review, antimicrobial dressings provide an advantage in improved healing (moderate strength of evidence), but there is insufficient evidence about the effectiveness of antimicrobial dressings compared with each other or with compression alone. Collagen dressings may improve the proportion of ulcers healed compared with compression alone (low strength of evidence), and allogenic bilayered human skin equivalents may promote more rapid healing (moderate strength of evidence), particularly among patients with long-standing venous leg ulcers, although this treatment did not affect post-treatment recurrence.
The review finds insufficient evidence available regarding the routine use of antibiotics and the effectiveness of advanced wound dressings on longer-term outcomes, including quality of life and pain. When added to compression, there is a moderate and low strength of evidence, respectively, that superficial vein surgery and surgical hemodynamic correction of reflux may lower the risk of ulcer recurrence, though neither improves healing. In contrast, subfascial endoscopic perforator vein surgery does not improve the rate of healing or risk of recurrence of chronic venous leg ulcers (high strength of evidence).
Overall, insufficient evidence exists to determine the comparative benefits and harms of different surgical procedures for chronic venous leg ulcers. Additional well-designed studies with adequate numbers of patients and standardized definitions are needed to determine the clinical impact of these treatments compared with the use of venous compression alone.
These findings are available in the research review, Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities available at http://go.usa.gov/ZMdA.
According to the review, antimicrobial dressings provide an advantage in improved healing (moderate strength of evidence), but there is insufficient evidence about the effectiveness of antimicrobial dressings compared with each other or with compression alone. Collagen dressings may improve the proportion of ulcers healed compared with compression alone (low strength of evidence), and allogenic bilayered human skin equivalents may promote more rapid healing (moderate strength of evidence), particularly among patients with long-standing venous leg ulcers, although this treatment did not affect post-treatment recurrence.
The review finds insufficient evidence available regarding the routine use of antibiotics and the effectiveness of advanced wound dressings on longer-term outcomes, including quality of life and pain. When added to compression, there is a moderate and low strength of evidence, respectively, that superficial vein surgery and surgical hemodynamic correction of reflux may lower the risk of ulcer recurrence, though neither improves healing. In contrast, subfascial endoscopic perforator vein surgery does not improve the rate of healing or risk of recurrence of chronic venous leg ulcers (high strength of evidence).
Overall, insufficient evidence exists to determine the comparative benefits and harms of different surgical procedures for chronic venous leg ulcers. Additional well-designed studies with adequate numbers of patients and standardized definitions are needed to determine the clinical impact of these treatments compared with the use of venous compression alone.
These findings are available in the research review, Chronic Venous Ulcers: A Comparative Effectiveness Review of Treatment Modalities available at http://go.usa.gov/ZMdA.
Current as of February 2014
Internet Citation: Treatment approaches for chronic venous ulcers reviewed: Comparative Effectiveness Research. February 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/research-activities/14feb/0214RA30.html
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