June
Issue
19 10 Dominik Heim: The 20th European Venous Forum (EVF)
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Raghu Kolluri: Role of elevated central venous pressure
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“Urgent action” is required to improve referral for venous ulcer patients Despite the recent emergence of Level 1 evidence supporting the early intervention of venous ulceration, Alun Davies (London, UK) warned at the Charing Cross Symposium (15–18 April, London UK) that the guidelines and recommendations are consistently being ignored, and highlighted that “urgent action is required for venous ulcer patients, to improve referral pathways between primary and secondary care”.
Alun Davies
V
enous ulcers on the lower leg can be a major source of patient distress and social isolation, Davies noted, substantially impacting the patient’s quality of life. What remains less immediately apparent, however, is the burden of this condition on health services. With an estimated cost of venous ulcers to the UK National Health Service (NHS) exceeding £1 billion each year, Davies pointed to forecasting of this figure to increase, given the UK’s ageing population and growing incidence of obesity. As principal investigator of the EVRA (Early venous
reflux ablation) ulcer trial, Davies presented the first Level 1 evidence supporting early intervention with ablation for venous ulcers in 2018. The EVRA trial, he told the CX audience one year on, was partly stimulated by the lack of translation of the UK National Institute for Health and Care Excellence (NICE) guidelines into clinical practice. In July 2013, it was recommended that patients with a venous leg ulcer should be referred to a vascular specialist within two weeks. However, this recommendation “usually went ignored” by healthcare Continued on page 2
Fedor Lurie:
Profile
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VenaSeal maintains safety and efficacy at extended fiveyear follow-up
The first-ever 60-month data on Medtronic’s VenaSeal closure system were presented at the Charing Cross Symposium (CX; 15–18 April, London, UK), indicating that at five years, treatment with the cyanoacrylate adhesive for closure of diseased vein segments was not inferior to the alternative treatment arm of radiofrequency ablation (RFA). Nick Morrison of the Center for Vein Restoration in Mesa, USA, delivered the outcomes during a superficial venous session at CX 2019. THE DATA WERE the result of long-term outcomes from the VeClose study, in a five-year follow-up extension of the trial’s original threeyear follow-up period. Morrison explained that, in order to continue to assess the safety and efficacy of the VenaSeal closure system for the long-term effect of the closure, the investigators “wanted to follow up as many patients as we could gather out to five years”. Of the original trial’s 222 patients, the extended VeClose study was able to enrol 89 patients, of which 47 had been randomised to VenaSeal cyanoacrylate and 33 randomised to RFA with Medtronic’s ClosureFast system; the remaining nine patients were roll-in cyanoacrylate patients. The primary endpoint of the extension study was complete closure, defined as Doppler ultrasound examination showing closure along the entirety of the treated target vein, with no discrete segments of patency exceeding 5cm. Among the randomised patients, this endpoint of closure rates was sustained over a long-term period, with “no new failures reported and noninferiority demonstrated through 60 months”. Morrison reported a 91.4% closure rate in the VenaSeal arm, vs. 85.2% in the RFA arm. Continued on page 2