The Early Venous Reflux Ablation (EVRA) ulcer study
|
|
|
- George Peters
- 5 years ago
- Views:
Transcription
1 The Early Venous Reflux Ablation (EVRA) ulcer study MS Gohel, F Heatley, X Liu, A Bradbury, R Bulbulia, N Cullum, DM Epstein, I Nyamekye, KR Poskitt, S Renton MS, J Warwick, AH Davies on behalf of the EVRA trial investigators Funded by the National Institute for Health Research (NIHR HTA) Programme (project number 11/129/197) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.
2 The Early Venous Reflux Ablation (EVRA) ulcer study RATIONALE AND STUDY METHODS Funded by the National Institute for Health Research (NIHR HTA) Programme (project number 11/129/197) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.
3 Background Neglected patient population with poor outcomes Cause of discomfort and social isolation Substantial cost burden
4 Referral pathways Family doctor/ Wound care center Vascular Specialist
5 ESCHAR study Surgery reduces venous ulcer recurrence No difference in ulcer healing
6 ESCHAR study 24% of patients randomised to surgery, refused an operation The study was not powered to assess ulcer healing (C5/C6 & mean time to treatment 7 weeks) A quarter of procedures were SFJ or SPJ ligation alone (local anaesthesia)
7 Cohort studies
8 Study aims Evaluate whether early endovenous ablation can improve venous ulcer healing in addition to compression therapy
9 Study design Extensive patient and public involvement Surveys and patient focus groups
10 Study design Compression + EVRA (within 2 weeks) Early group Venous leg ulcer Superficial venous reflux Compression + deferred ablation Deferred group Study powered to detect 15% difference in 24-week healing rate (60% vs 75%) with 90% power and 5% significance Sample size 450 patients (254 healing events)
11 Study design INCLUSION CRITERIA Patient age > 18 years Leg ulceration of duration between 6 weeks and 6 months ABPI > 0.8 Primary or recurrent superficial reflux deemed to warrant ablation by the treating clinician EXCLUSION CRITERIA Unable to tolerate compression Significant deep venous occlusive disease (as assessed by local clinical team) Ulcer of non-venous aetiology Patient deemed to require skin grafting Pregnancy
12 Interventions ALL TRIAL PATIENTS Effective compression therapy Wound care / dressings as per local policy Compression stocking once ulcer healed Early Endovenous ablation within 2 weeks of randomisation Deferred Endovenous ablation once ulcer healed (or if unhealed at 6 months)
13 Interventions DETAILS OF ENDOVENOUS INTERVENTIONS Treatment modality and strategy determined by treating clinical team PRINCIPLES Ablate incompetent truncal vein Treat to lowest point of reflux if possible Continue compression immediately after intervention
14 Outcome measures PRIMARY OUTCOME MEASURE Time to ulcer healing SECONDARY OUTCOMES Ulcer healing rate Ulcer free time to 1 year Venous Clinical Severity Score (VCSS) Quality of life (AVVQ, EQ-5D-5L, SF36) Cost effectiveness
15 Statistical analysis ULCER HEALING Unadjusted Cox regression model with recruiting centre as a random effect (prespecified analysis) ULCER FREE TIME Ulcer free time assessed in patients who completed follow-up to 1 year post-randomisation Effect of EVRA on ulcer free time assessed using ordered logistic regression
16 Summary
17 The Early Venous Reflux Ablation (EVRA) ulcer study RECRUITMENT AND DEMOGRAPHICS Funded by the National Institute for Health Research (NIHR HTA) Programme (project number 11/129/197) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.
18 Trial centres London (Prof Alun Davies) Cheltenham (Mr Keith Poskitt) Worcester (Mr Isaac Nyamekye) Harrow (Miss Sophie Renton) Cambridge (Mr Manjit Gohel) HEFT (Prof Andrew Bradbury) UHB (Mr Rajiv Vohra) Dudley/Wolverhampton (Mr Andrew Garnham) York (Mr Andrew Thompson) Hull (Mr Daniel Carradice) Bournemouth (Mr Dynesh Rittoo) Plymouth (Mr Jamie Barwell) Frimley Park (Mr Patrick Chong) Carlisle (Mr Thomas Joseph) Leeds (Prof Julian Scott) Salisbury (Miss Sarah Hulin) Bradford (Mr Kevin Mercer) Sheffield (Mr Dominic Dodd) Taunton (Mr James Coulston)
19 Recruitment Oct 2013 Sep Screened EXCLUSIONS (n=6105) 1772 Ulcer >6 months 873 ABPI < Ulcer healed 568 Not an ulcer 496 Clinician decision 434 Patient declined 378 No venous reflux 974 Other reason Overall inclusion rate of 7% 224 Early 450 Consented 226 Deferred 31 lost to follow-up / withdrew 12 died 387 per protocol
20 Baseline characteristics Early Deferred N=224 N=226 Age 67.0 (15.5) [n=224] 68.9 (14.0) [n=226] BMI (kg/m 2 ) 30.1 (7.8) [n=218] 30.4 (7.4) [n=219] Gender Female 97 (43.3%) 106 (46.9%) Male 127 (56.7%) 120 (53.1%) Previous DVT in trial leg No 206 (93.3%) 203 (93.4%) Yes 15 (6.7%) 15 (6.6%) Mean (SD) presented for Age and BMI
21 Ulcer characteristics Early Deferred N=224 N=226 Ulcer chronicity (months) 3.2 ( ) 3.0 ( ) Ulcer size (cm 2 ) 2.4 ( ) 2.9 ( ) Previous ulcer (yes) No 106 (47.3%) 108 (48.0%) Yes 118 (52.7%) 117 (52.0%) Baseline Compression None 3 (1.3%) 7 (3.1%) KTwo 32 (14.3%) 29 (12.8%) Three-layer bandage 42 (18.8%) 41 (18.1%) Four-layer bandage 59 (26.3%) 59 (26.1%) European short stretch 43 (19.2%) 36 (15.9%) Stocking 42 (18.8%) 53 (23.5%) Other 2 (0.9%) 1 (0.4%) Missing 1 (0.4%) 0 (0%)
22 Baseline reflux patterns Early Deferred N=224 N=226 Superficial venous reflux GSV reflux alone 123 (54.9%) 125 (55.4%) SSV reflux alone 25 (11.2%) 30 (13.3%) GSV and SSV reflux 65 (29.0%) 56 (24.8%) Other pattern of reflux 11 (4.9%) 15 (6.6%) Deep veins Normal 150 (67.0%) 157 (69.5%) Abnormal 74 (33.0%) 69 (30.5%) Reflux 74 (100%) 69 (100%) Outflow obstruction 0 (0%) 0 (0%)
23 The Early Venous Reflux Ablation (EVRA) ulcer study STUDY RESULTS Funded by the National Institute for Health Research (NIHR HTA) Programme (project number 11/129/197) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.
24 Ulcer healing Early Deferred Unadjusted hazard ratio for ulcer healing in Early group: 1.38 (95% CI ) p=0.001
25 Ulcer healing Early Deferred N=224 N= week ulcer healing rate 63.5% 51.6% 24-week ulcer healing rate 85.6% 76.3%
26 Ulcer healing: subgroups
27 Ulcer free time Early Deferred N=224 N=226 No. patients with ulcer healed at 1 year 210 (93.8%) 194 (85.8%) No. patients with recurrent ulcer 24 (11.4%) 32 (16.5%) Ulcer free time (days) 306 ( ) [n=204] 278 ( ) [n=203] Hazard ratio for ulcer free time in Early group: 1.54 (95% CI ) p=0.02
28 VCSS Early Deferred p value N=224 N=226 VCSS total score Baseline 15.8 (3.3) [n=223] 15.7 (3.1) [n=226] 0.62 Week (4.7) [n=218] 12.6 (4.4) [n=210] <0.001
29 Quality of life AVVQ Baseline 6 weeks 6 months 12 months Deferred 44.3 (8.7) [n=192] 41.2 (9.3) [n=170] 39.5 (10.3) [n=140] 34.3 (10.4) [n=130] Early 44.1 (9.0) [n=200] 39.4 (10.2) [n=176] 34.6 (9.4) [n=139] 32.4 (8.3) [n=127] Difference -0.2 (-2.0, 1.6) p= (-4.0, -0.2) p= (-6.9, -2.7) p< (-4.0, 0.3) p=0.10 EQ-5D Index score Baseline 6 weeks 6 months 12 months Deferred 0.73 (0.2) [n=226] 0.75 (0.2) [n=208] 0.76 (0.2) [n=192] 0.80 (0.2) [n=182] Early 0.73 (0.2) [n=222] 0.79 (0.2) [n=211] 0.81 (0.2) [n=186] 0.83 (0.2) [n=184] Difference (-0.04, 0.03) p= (0.00, 0.08) p= (0.00, 0.08) p= (-0.01, 0.07) p=0.19 SF-36 Body Pain Baseline 6 weeks 6 months 12 months Deferred 41.6 (11.9) [n=224] 44.3 (12.3) [n=207] 45.9 (12.2) [n=193] 47.8 (11.2) [n=180] Early 41.3 (11.1) [n=223] 46.6 (10.6) [n=212] 48.2 (11.0) [n=187] 49.3 (11.0) [n=182] Difference -0.5 (-2.6, 1.6) p= ( 0.1, 4.4) p= (-0.2, 4.3) p= (-1.1, 3.3) p=0.34
30 Timing of intervention Early Deferred N=224 N=226 No treatment 6 (2.7%) 55 (24.3%) Within 2-weeks 203 (90.6%) 1 (0.4%) Before ulcer healing After ulcer healing 3 0 Between 2-week and 4-week 9 (4.0%) 1 (0.4%) Before ulcer healing 9 1 After ulcer healing 0 0 Between 4-week and 6-month 6 (2.7%) 103 (45.6%) Before ulcer healing 4 4 After ulcer healing 2 99 After 6-month 0 (0%) 66 (29.2%) Before ulcer healing 0 19 After ulcer healing 0 47
31 Procedure complications Early Deferred N=28 N=24 Allergic reaction requiring local or no treatment 5 3 Bleeding requiring intervention 2 1 Cough / chest tightness 0 1 Deep vein thrombosis (DVT) 9 3 Infection 3 5 Edema 1 0 Pain 6 6 Patient reported paresthesia 1 1 Superficial thrombophlebitis 1 4
32 Clinical effectiveness Early endovenous ablation (in addition to compression therapy) was associated with: - shorter time to healing - greater ulcer free time
33 The Early Venous Reflux Ablation (EVRA) ulcer study HEALTH ECONOMIC ANALYSIS Funded by the National Institute for Health Research (NIHR HTA) Programme (project number 11/129/197) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.
34 Cost effectiveness: methods Within trial (one year, no discounting) NHS and personal social services perspective 2015/16 prices Included ulcer and treatment-related costs Quality adjusted life years (QALYs) estimated from EQ-5D-5L instrument Complete cases in base-case analysis Bootstrap for estimating standard errors Cost-effectiveness acceptability curve Sensitivity analyses: (1) imputation of missing data (2) alternative EQ-5D-5L tariff
35 ,000 1,500 2,000 2,500 Results 2442 (SD 3216) 2496 (SD 2775) Other Other Outpatient visits Outpatient visits Admissions to hospital Home care Admissions to hospital Home care Wound care consumables Primary & community care Primary and community care Wound care consumables Primary & community care Primary and community care Trial Procedures procedures Trial Procedures procedures Deferred Early
36 Cost effectiveness Difference in cost over 1 year Difference in QALY over 1 year Complete cases (N=345) 227 (317) p= (0.011) p=0.017 Multiple imputation (N=450) 26 (287) p= (0.017) p=0.001 Incremental costeffectiveness ratio 5593/ QALY 408/ QALY Mean (SE) presented
37 Cost effectiveness 86 99% probability that early intervention is cost-effective at threshold of 20,000 / QALY
38 The Early Venous Reflux Ablation (EVRA) ulcer study CONCLUSIONS Funded by the National Institute for Health Research (NIHR HTA) Programme (project number 11/129/197) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.
39 Conclusions EVRA is the first large randomised trial to confirm that early endovenous ablation accelerates ulcer healing Early endovenous ablation also associated with greater ulcer free time and is cost effective
40 Implications Rapid assessment and ablation of superficial venous reflux for patients with venous leg ulcers Major review of leg ulcer care pathways needed (worldwide) Education of patients, nursing teams, healthcare professionals and commissioners is essential
41 Funded by the National Institute for Health Research (NIHR HTA) Programme (project number 11/129/197) The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration
Original Article A Randomized Trial of Early Endovenous Ablation in Venous Ulceration Manjit S. Gohel, M.D., Francine Heatley, B.Sc., Xinxue Liu, Ph.D., Andrew Bradbury, M.D., Richard Bulbulia, M.D., Nicky
Comparative cost-effectiveness of four-layer bandaging in the treatment of venous leg ulceration Carr L, Philips Z, Posnett J
Comparative cost-effectiveness of four-layer bandaging in the treatment of venous leg ulceration Carr L, Philips Z, Posnett J Record Status This is a critical abstract of an economic evaluation that meets
A one stop vein shop: the ideal option?
A one stop vein shop: the ideal option? Professor Alun H Davies Section of Vascular Surgery Imperial College, Charing Cross & St Mary s Hospitals London Conflicts of Interest None to declare Which treatment?
RCT on GCS/LMWH vs LMWH in VTE prophylaxis
RCT on GCS/LMWH vs LMWH in VTE prophylaxis GAPS: Graduated compression as an Adjunct to Pharmacoprophylaxis in Surgery A Multi-Centre Randomised Clinical Trial Joseph Shalhoub, Alun H Davies on behalf
New Guideline in venous ulcer treatment: dressing, medication, intervention
New Guideline in venous ulcer treatment: dressing, medication, intervention Kittipan Rerkasem, FRCS(T), PhD Department of Surgery Faculty of Medicine Chiang Mai University Topic Overview venous ulcer treatment
Conflict of Interest. None
Conflict of Interest None American Venous Forum Guidelines on Superficial Venous Disease TOP 10 GUIDELINES 10. We recommend using the CEAP classification to describe chronic venous disorders. (GRADE 1B)
Do Venous Procedures Have an Impact on Quality of Life? Mark H. Meissner, MD Professor of Surgery University of Washington Seattle, WA USA
Do Venous Procedures Have an Impact on Quality of Life? Mark H. Meissner, MD Professor of Surgery University of Washington Seattle, WA USA Venous Outcome Measures Technical Clinical Functional Acute DVT
Venous interventions in venous treatment and recurrence avoidance an overview
Venous interventions in venous treatment and recurrence avoidance an overview Professor Alun H Davies Section of Vascular Surgery Charing Cross & St Mary s Hospitals London Introduction Common, distressing
Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015
Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015 Anatomy of Perforating veins Cadaveric studies 1 have shown >60 vein perforating veins from superficial to deep Normal
Endovenous Thermal vs. Endovenous Chemical Ablation What is the Best for the Patient
Endovenous Thermal vs. Endovenous Chemical Ablation What is the Best for the Patient T. Noppeney, J. Noppeney Center for Vascular Diseases: Outpatient Dept. Obere Turnstrasse, Dept. for Vascular Surgery
Venous Leg Ulcers: Wound Risk Assessment and Prevention. Prof. Helen Edwards, OAM
Venous Leg Ulcers: Wound Risk Assessment and Prevention Prof. Helen Edwards, OAM Queensland University of Technology, Brisbane Prof. H. Edwards, Dr K. Finlayson, M. Gibb, C. Parker Royal District Nursing
London Choosing Wisely. Draft Policy Template: Varicose Veins. Version Date Notes. Draft for T&F 1 25/04/18 Initial Draft
London Choosing Wisely Draft Policy Template: Varicose Veins Version Date Notes Draft for T&F 1 25/04/18 Initial Draft Revised version post T&F 1 15/05/18 Revised version 07/06/18 Revised version 25/06/18
Appendix 7c Varicose Veins Task and Finish Group meeting, 3 May 2018 Notes of key discussion points
Appendix 7c Varicose Veins Task and Finish Group meeting, 3 May 2018 Notes of key discussion points Task and Finish Group members Attendees: Stella Vig Vascular Consultant Surgeon & Clinical SWL Director
Setting The setting was an outpatients department. The economic study was carried out in the UK.
Effectiveness and cost-effectiveness of three types of physiotherapy used to reduce chronic low back pain disability: a pragmatic randomized trial with economic evaluation Critchley D J, Ratcliffe J, Noonan
Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach.
Management of Venous Disease: an evidence based approach Disclosures Ed Boyle, MD Andrew Jones, MD Dr. Ed Boyle and Dr. Andrew Jones disclose Grants/research support: Medtronic, BTG International, Clearflow,
Kathleen Gibson, MD FACS Lake Washington Vascular Surgeons, Bellevue, WA, USA
Cyanoacrylate Closure of Incompetent Great, Small and Accessory Saphenous Veins without the use of Post-Procedure Compression: Post-Market Evaluation of the VenaSeal System (WAVES trial): 12 Month Data
2017 Florida Vascular Society
Current Management of Venous Leg Ulcers: How to Identify Patients with Correctable Venous Disease and Interventional Procedures to Heal and Prevent Recurrence 2017 Florida Vascular Society Bill Marston
Cost and dressing evaluation of hydrofiber and alginate dressings in the management of community-based patients with chronic leg ulceration
Cost and dressing evaluation of hydrofiber and alginate dressings in the management of community-based patients with chronic leg ulceration Harding K G, Price P, Robinson B, Thomas S, Hofman D Record Status
Chronic venous leg ulcers: Effects of foam sclerotherapy on healing and recurrence
Original Article Chronic venous leg ulcers: Effects of foam sclerotherapy on healing and recurrence Phlebology 2016, Vol. 31(1) 34 41! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalspermissions.nav
Patient assessment and strategy making for endovenous treatment
Patient assessment and strategy making for endovenous treatment Raghu Kolluri, MD Director Vascular Medicine OhioHealth Riverside Methodist Hospital Columbus, OH Disclosures Current Medtronic Consultant/
Vein Disease Treatment
MP9241 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes as indicated in 2.0, 3.0, 4.0 and 5.0 Additional Information: None Prevea360 Health Plan Medical Policy: Vein disease
JoyTickle, Tissue Viability Nurse Specialist, Shropshire Community Health NHS Trust
Lower limb Ulceration Pathway: Leanne Atkin, Lecturer practitioner/vascular Nurse Specialist, School of Human and Health Sciences, University of Huddersfield and Mid Yorkshire NHS Trust, E mail: l.atkin@hud.ac.uk
Priorities Forum Statement
Priorities Forum Statement Number 9 Subject Varicose Vein Surgery Date of decision September 2014 Date refreshed March 2017 Date of review September 2018 Relevant OPCS codes: L841-46, L848-49, L851-53,
Dr Paul Thibault. Phlebologist & Assistant Editor Phlebology (International Journal) Australasian College of Phlebology
Dr Paul Thibault Phlebologist & Assistant Editor Phlebology (International Journal) Australasian College of Phlebology Prescribing Effective Compression and PTS Dr Paul Thibault Phlebologist, Newcastle,
PATCH Analysis Plan v1.2.doc Prophylactic Antibiotics for the Treatment of Cellulitis at Home: PATCH Analysis Plan for PATCH I and PATCH II Authors: Angela Crook, Andrew Nunn, James Mason and Kim Thomas,
OHTAC Recommendation. Endovascular Laser Treatment for Varicose Veins. Presented to the Ontario Health Technology Advisory Committee in November 2009
OHTAC Recommendation Endovascular Laser Treatment for Varicose Veins Presented to the Ontario Health Technology Advisory Committee in November 2009 April 2010 Issue Background The Ontario Health Technology
Reality TV Managing patients in the real world. Wounds UK Harrogate 2009
Reality TV Managing patients in the real world Wounds UK Harrogate 2009 Reality TV Managing patients in the real world Brenda M King Nurse Consultant Tissue Viability Sheffield PCT Harrogate 2009 Familiar
Type of intervention Other: transplantation. Economic study type Cost-utility analysis.
Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups Longworth L, Young T, Buxton M J, Ratcliffe J, Neuberger J, Burroughs A, Bryan S Record Status
Case. Wounds. Fundamentals of Ulcer Care. Dr. Mark Meissner Wound Case Study. Compression and Ulcer Healing Cullum NA, Cochrane Reviews 2001
Case Wounds Mark H. Meissner, MD University of Washington School of Medicine 65 yr old male physician Recurrent R medial malleolar ulcer over 5 years New R lateral malleolar ulcer Intermittently wearing
o Self-Contained & Disposable: Fully self-contained, single-use device with no need for capital equipment purchase
The ClariVein OC Proprietary dual action device^ ClariVein OC is a specialty catheter for the infusion of physician-specified agents in the peripheral vasculature including for endovascular occlusion of
West Gloucestershire Primary Care Trust Community Nursing Service. Leg Ulcer Audit. Gloucestershire Primary & Community Care Audit Group
West Gloucestershire Primary Care Trust Community Nursing Service Leg Ulcer Audit 2006 Gloucestershire Primary & Community Care Audit Group Contents Page number Background 3 Audit Aims 4 Methodology 4
Level 2 Leg Ulcer Management Service. Service Level Agreement Background. Contents:
Level 2 Leg Ulcer Management Service Service Level Agreement 2016-2019 Contents: 1. Background to Leg Ulcer Management Service 2. Service Details 3. Accreditation 4. Service Standards 5. Finance Details
Chronic Venous Insufficiency Compression and Beyond
Disclosure of Conflict of Interest Chronic Venous Insufficiency Compression and Beyond Shawn Amyot, MD, CCFP Fellow of the Canadian Society of Phlebology Ottawa Vein Centre I do not have relevant financial
Ultrasound-Guided Foam Sclerotherapy for the Treatment of Chronic Venous Ulceration: A Preliminary Study
Eur J Vasc Endovasc Surg (2009) 38, 764e769 Ultrasound-Guided Foam Sclerotherapy for the Treatment of Chronic Venous Ulceration: A Preliminary Study K.A.L. Darvall a,b, *, G.R. Bate a, D.J. Adam a, S.H.
Additional Information S-55
Additional Information S-55 Network providers are encouraged, but not required to participate in the on-line American Venous Forum Registry (AVR) - The First National Registry for the Treatment of Varicose
HEALTH TECHNOLOGY ASSESSMENT
HEALTH TECHNOLOGY ASSESSMENT VOLUME 19 ISSUE 27 APRIL 2015 ISSN 1366-5278 Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins:
MOCA and GLUE: results and analyses of the RCTs
MOCA and GLUE: results and analyses of the RCTs Faculty disclosure Research Grant Medtronic Educational Grant mediusa Speakers Bureau Medtronic Pierre Fabre mediusa Medical Director Morrison Vein/Training
Chronic Venous Insufficiency
Chronic Venous Insufficiency None Disclosures Lesley Enfinger, MSN,NP-C Chronic Venous Insufficiency Over 24 Million Americans affected by Chronic Venous Insufficiency (CVI) 10 x More Americans suffer
Quality of Life Evaluation and Chronic Venous Disease: How to carry this out during our daily practice? Armando Mansilha MD, PhD, FEBVS
Quality of Life Evaluation and Chronic Venous Disease: How to carry this out during our daily practice? Armando Mansilha MD, PhD, FEBVS Faculty Disclosure Armando Mansilha I have no financial relationships
Treatment of Venous ulcers utilizing n-butyl Cyanoacrylate (Super Glue)
Treatment of Venous ulcers utilizing n-butyl Cyanoacrylate (Super Glue) Awais Siddique MD Endovascular Radiologist AZH WAVE CENTERS Milwaukee WI Venous disease Etiology Are the result of Venous valvular
Ambulatory Varicosity avulsion Later or Synchronised (AVULS): A Randomised Clinical Trial
MiniAbstract Ambulatory Varicosity avulsion Later or Synchronised (AVULS): A Randomised Clinical Trial Tristan R A Lane 1, Damian Kelleher 2, Amanda C Shepherd 1, Ian J Franklin 1,3 and Alun H Davies 1
Clinical case. Symptomatic anterior accessory great saphenous vein (AAGSV) reflux
Clinical case Symptomatic anterior accessory great saphenous vein (AAGSV) reflux A 70 year-old female presents with symptomatic varicose veins on left leg for more than 10 years. She complains of heaviness,
Deep Venous Pathology. Eberhard Rabe Department of Dermatology University of Bonn Germany
Deep Venous Pathology Eberhard Rabe Department of Dermatology University of Bonn Germany Disclosures None for this presentation Consultant: Sigvaris, EUROCOM Speakers bureau: Bayer Vital, Aspen, Boehringer,
The Influence of Superficial Venous Surgery and Compression on Incompetent Calf Perforators in Chronic Venous Leg Ulceration
Eur J Vasc Endovasc Surg 29, 78 82 (2005) doi:10.1016/j.ejvs.2004.09.016, available online at http://www.sciencedirect.com on The Influence of Superficial Venous Surgery and Compression on Incompetent
Endo-Thermal Heat Induced Thrombosis (E-HIT)
Endo-Thermal Heat Induced Thrombosis (E-HIT) Michael Ombrellino MD FACS The Cardiovascular Care Group Clinical Associate Professor of Surgery Rutgers School of Medicine Objectives: What is E-HIT? How do
How varicose veins occur
Varicose veins are a very common problem, generally appearing as twisting, bulging rope-like cords on the legs, anywhere from groin to ankle. Spider veins are smaller, flatter, red or purple veins closer
Clinical outcomes and cost-effectiveness of three different compression systems in newly-diagnosed venous leg ulcers in the UK
journal of wound care C W C VOLUME 26. NUMBER 5. MAY 2017??? Clinical outcomes and cost-effectiveness of three different compression systems in newly-diagnosed venous leg ulcers in the UK *J.F. Guest,
How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN.
How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN Surgeon Dr G Mark Malouf Sydney Australia Following History and Physical examination
Srovnání 2 typů radiálních laserových vláken (1-ringových a 2-ringových) v nitrožilní léčbě křečových žil pomocí laseru o vlnové délce 1470 nm
Srovnání 2 typů radiálních laserových vláken (1-ringových a 2-ringových) v nitrožilní léčbě křečových žil pomocí laseru o vlnové délce 1470 nm Robert Vlachovský, Robert Staffa, Ernest Biroš II. chirurgická
NICE AAA Guidelines. Professor Andrew W. Bradbury
NICE AAA Guidelines Professor Andrew W. Bradbury Sampson Gamgee Professor of Vascular Surgery University of Birmingham, UK Thursday 29 November 2018 14.00-14.15 Alsh NICE Guidelines: international reputation
RESEARCH ABSTRACT. Cheltenham, Gloucester GL53 7AN 2 Derriford Hospital, Plymouth. HS Trust, Gloucester 5 Gloucestershire Royal Hospital,
1 Cheltenham General Hospital, Cheltenham, Gloucester GL53 7AN 2 Derriford Hospital, Plymouth 3 Southmead Hospital, Bristol 4 Gloucestershire Hospitals N HS Trust, Gloucester 5 Gloucestershire Royal Hospital,
The role of ultrasound duplex in endovenous procedures
The role of ultrasound duplex in endovenous procedures Neophytos A. Zambas MD, PhD Vascular Surgeon Polyclinic Ygia, Limassol, Cyprus ΚΕΑΕΧ ΚΥΠΡΙΑΚΗ ΕΤΑΙΡΕΙΑ ΑΓΓΕΙΑΚΗΣ ΚΑΙ ΕΝΔΑΓΓΕΙΑΚΗΣ ΧΕΙΡΟΥΡΓΙΚΗΣ Pre
HEALTH TECHNOLOGY ASSESSMENT
HEALTH TECHNOLOGY ASSESSMENT VOLUME 17 ISSUE 48 OCTOBER 2013 ISSN 1366-5278 Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review
Dr Peter Chapman-Smith
Dr Peter Chapman-Smith Phlebologist NZ Stem Cell Treatment Centre, Whangarei 12:00-12:30 Healing Those Heartsink Leg Ulcers Healing Those Heartsink Leg Ulcers Practice Nurses Presentation GPCME Christchurch
Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington
Clinical Review Criteria Treatment of Varicose Veins Radiofrequency Catheter Closure Sclerotherapy Surgical Stripping Trivex System for Outpatient Varicose Vein Surgery VenaSeal Closure System VNUS Closure
PROVIDER POLICIES & PROCEDURES
PROVIDER POLICIES & PROCEDURES TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES STAB PHLEBECTOMY AND SCLEROTHERAPY TREATMENT The primary purpose of this document is to assist providers enrolled in
Efficacy of Velcro Band Devices in Venous and. Mixed Arterio-Venous Patients
Efficacy of Velcro Band Devices in Venous and Mixed Arterio-Venous Patients T. Noppeney Center for Vascular Diseases: Outpatient Dept. Obere Turnstrasse, Dept. for Vascular Surgery Martha-Maria Hospital
NHS RightCare scenario: The variation between standard and optimal pathways
January 2017 NHS RightCare scenario: The variation between standard and optimal pathways Betty s story: Wound care Appendix 1: Summary slide pack January 2017 Betty s story This is the story of Betty s
Selection and work up for the right patients suspected of deep venous disease
Selection and work up for the right patients suspected of deep venous disease R A G H U K O L L U R I, M S, M D, R V T S Y S T E M M E D I C A L D I R E C T O R V A S C U L A R M E D I C I N E / V A S
Type of intervention Screening and treatment. Economic study type Cost-utility analysis.
Cost-effectiveness of testing for hypercoagulability and effects on treatment strategies in patients with deep vein thrombosis Auerbach A D, Sanders G D, Hambleton J Record Status This is a critical abstract
Mindful Reflections On The Management. of Venous Ulceration. Presenter name. Title Date
C Scott McEnroe, MD, FACS Medical Director Vein Center of Virginia Sentara Vascular Specialists April 25 th, 2014 Mindful Reflections On The Management of Venous Ulceration Approximately 97 % of all statistics
A study of clinical profile of varicose veins in our tertiary care center: a randomized prospective observational study
International Surgery Journal Jaykar RD et al. Int Surg J. 2016 Aug;3(3):1517-1523 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20162739
Page 1. Ruling out deep venous obstruction prior to superficial vein treatment. Disclosures. Indications for saphenous vein ablation (SVA)
1 Ruling out deep venous obstruction prior to superficial vein treatment Deepak Sudheendra, MD, RPVI Assistant Professor of Clinical Radiology & Surgery Disclosures No financial disclosures Indications
Kathleen Gibson, MD. Lake Washington Vascular Surgeons Bellevue, WA
Cyanoacrylate Closure of Incompetent Great, Small and Accessory Saphenous Veins without the use of Post-Procedure Compression: a Post-Market Evaluation of the VenaSeal System (WAVES trial): Three Month
Health technology The use of four-layer compression bandaging (4LB) versus alternative dressings for the treatment of venous ulcers.
Randomized clinical trial and economic analysis of four-layer compression bandaging for venous ulcers O'Brien J F, Grace P A, Perry I J, Hannigan A, Clarke Moloney M, Burke P E Record Status This is a
VENOUS LEG ULCERS (VLU)
VENOUS LEG ULERS (VLU) REOMMENDTION S Evidence-based gradings Excellent evidence ody of evidence can be trusted to guide practice. Good evidence ody of evidence can be trusted to guide practice in most
Protocols for the evaluation of lower extremity venous reflux: supine, sitting, or standing?
Protocols for the evaluation of lower extremity venous reflux: supine, sitting, or standing? Susan Whitelaw RVT, RDMS PURPOSE Duplex imaging of the lower extremity veins is performed to assess the deep
Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous vein
Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous vein Raghu Kolluri, MD, Director Vascular Medicine OhioHealth Riverside Methodist Hospital
What can we learn from randomized trials comparing endovenous and open surgery for primary varicosis? an overview Prof. Dr. Thomas M.
What can we learn from randomized trials comparing endovenous and open surgery for primary varicosis? an overview Prof. Dr. Thomas M. Proebstle Department of Dermatology, University Medical Center Mainz,
Velcro Compression Devices
Velcro Compression Devices Joseph A. Caprini, MD, MS, FACS, RVT, FACCWS Louis W. Biegler Chair of Surgery NorthShore University HealthSystem, Evanston, IL Clinical Professor of Surgery University of Chicago
Varicose veins. Information for patients Sheffield Vascular Institute
Varicose veins Information for patients Sheffield Vascular Institute You have been diagnosed as having varicose veins. This leaflet explains more about varicose veins and answers some of the most frequently
BASIL Investigators Meeting Vascular Society Manchester 1 December 2016
BASIL Investigators Meeting Vascular Society Manchester 1 December 2016 BASIL Introduction and Overview Professor Andrew Bradbury Chief Investigator BASIL Trials Overview Severe Limb Ischaemia (SLI) (RP
Treatment of Chronic Venous Ulcers Using New Four Layers Compressive Bandage Dressing
ORIGINAL ARTICLE J Nepal Med Assoc 215;53(199):156-61 CC S BY NC OPEN ACCESS Treatment of Chronic Venous Ulcers Using New Four Layers Compressive Bandage Dressing Kaushal K Tiwari, 1 Krishna G Shrestha,
It is estimated that 730,000 patients suffer with
The leg ulceration pathway: impact of implementation Leg ulceration continues to be a common cause of suffering for patients and the treatment of these patients continues to place a significant burden
Endovenous laser obliteration for the treatment of primary varicose veins Vuylsteke M, Van den Bussche D, Audenaert E A, Lissens P
Endovenous laser obliteration for the treatment of primary varicose veins Vuylsteke M, Van den Bussche D, Audenaert E A, Lissens P Record Status This is a critical abstract of an economic evaluation that
DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality
This document is scheduled to be published in the Federal Register on 06/10/2016 and available online at http://federalregister.gov/a/2016-13761, and on FDsys.gov Billing Code: 4160-90-M DEPARTMENT OF
COMMISSIONING POLICY
Ref No. 1a7.5 COMMISSIONING POLICY Surgery for venous disease of the leg (Varicosities of the Long Saphenous Vein) April 2011 CONTENTS Section Page Summary 2 1. Background 2 2. Criteria for eligibility
Varicose veins are dilated
Investigating and managing varicose veins in practice Varicose veins are common, and are usually caused by weak vein walls and valves. Most people with varicose veins will not have any complications at
Source of effectiveness data The effectiveness evidence was derived from a review of published studies.
Cost and cost effectiveness of venous and pressure ulcer protocols of care Kerstein M D, Gemmen E, van Rijswijk L, Lyder C H, Phillips T, Xakellis G, Golden K, Harrington C Record Status This is a critical
Basic Economic Analysis. David Epstein, Centre for Health Economics, York
Basic Economic Analysis David Epstein, Centre for Health Economics, York Contents Introduction Resource use and costs Health Benefits Economic analysis Conclusions Introduction What is economics? Choices
Table XI. Reference Abstracts corresponding to references can be found using the listing RCTs by alphabetical order or RCTs by topic.
Table XI. Operative procedure EVLA with different wavelengths HL+ EVLA EVLA without HL EVLA GSV ablation AK GSV ablation AK+BK Reference Abstracts corresponding to references can be found using the listing
pressure of compression stockings matters (clinical importance of pressure)
Classification of Compression Stockings ICC Meeting, Copenhagen, May 17, 2013. pressure of compression stockings matters (clinical importance of pressure) Giovanni Mosti; Lucca, Italy disclosure no conflict
Endovenous Laser Ablation (EVLA) to Treat Recurrent Varicose Veins
Eur J Vasc Endovasc Surg (2011) 41, 691e696 Endovenous Laser Ablation (EVLA) to Treat Recurrent Varicose Veins N.S. Theivacumar, M.J. Gough* Leeds Vascular Institute, The General Infirmary at Leeds, Great
FIND RELIEF FROM VARICOSE VEINS. VenaSeal Closure System
FIND RELIEF FROM VARICOSE VEINS VenaSeal Closure System UNDERSTAND Varicose veins may be a sign of something more severe venous reflux disease Your doctor can help you understand if you have this condition.
Reducing venous leg ulcers by fifty per cent in next 10 years: taking the first steps
Medicine, Nursing and Health Sciences Reducing venous leg ulcers by fifty per cent in next 10 years: taking the first steps Dr Carolina Weller Senior Research Fellow NHMRC/PHCRED Postdoctoral Research
Management of Post-Thrombotic Syndrome
Management of Post-Thrombotic Syndrome Thanainit Chotanaphuti Phramongkutklao College of Medicine Bangkok, Thailand President of CAOS Asia President of Thai Hip & Knee Society President of ASEAN Arthroplasty
Long-term follow up for different varicose vein therapies: is surgery still. the best?
Long-term follow up for different varicose vein therapies: is surgery still the best? Mr Roshan BOOTUN [BSc, MBBS, MRCS] Clinical Research Fellow in Vascular Surgery Professor Alun H. DAVIES [BA, BM BCh,
Recurrent Varicose Veins We All See Them
We All See Them November 4, 2017 Austin, TX Arlington Heights, IL No conflicts Terminology REVAS REcurrent Varices After Surgery PREVAIT PREsence of Varices After Interventional Treatment Recurrent varices
NCVH. Ultrasongraphy: State of the Art Vein Forum 2015 A Multidisciplinary Approach to Otptimizing Venous Circulation From Wounds to WOW
Ultrasongraphy: State of the Art 2015 NCVH New Cardiovascular Horizons Vein Forum 2015 A Multidisciplinary Approach to Otptimizing Venous Circulation From Wounds to WOW Anil K. Chagarlamudi, M.D. Cardiovascular
Date: A. Venous Health History Form. Patient please complete questions Primary Care Physician:
E S Insurance: 2 nd Insurance: Wait time: Date: A. Venous Health History Form Patient please complete questions 1-12 Patient Name: SSN#: Date of Birth: Primary Care Physician: What is the reason for your
Comparison of Monopolar and Segmental Radiofrequency Ablation in the Treatment of Lower Limb Chronic Venous Insufficiency
ARC Journal of Surgery Volume 4, Issue 3, 218, PP 5-1 ISSN 2455-572X DOI: http://dx.doi.org/1.2431/2455-572x.432 www.arcjournals.org Comparison of Monopolar and Segmental Radiofrequency Ablation in the
Cost-utility analysis of great saphenous vein ablation with radiofrequency, foam and surgery in the emerging health-care setting of Thailand
Original Article Cost-utility analysis of great saphenous vein ablation with radiofrequency, foam and surgery in the emerging health-care setting of Thailand Phlebology 2016, Vol. 31(8) 573 581! The Author(s)
Understanding compression bandages. Leg Ulcer Management Team Patient Information Leaflet
Understanding compression bandages Leg Ulcer Management Team Patient Information Leaflet Introduction Your leg ulcer clinic coordinator, nurse or healthcare professional has recommended that you have compression
Multiple Interventions for Diabetic Foot Ulcer Treatment Trial (MIDFUT)
Multiple Interventions for Diabetic Foot Ulcer Treatment Trial (MIDFUT) Nikki Dewhirst MIDFUT Clinical Co-ordinator, Clinical Trials Research Unit, University of Leeds Senior Vascular Research Nurse, Leeds
Long Term Outcome of Minimally Invasive. of the Lower Limb
Long Term Outcome of Minimally Invasive Treatment for Superficial Venous Insufficiency of the Lower Limb Joseph El-Sheikha Medical Doctorate (MD) Hull York Medical School (HYMS) (University of Hull, University
Find From Varicose Veins. VenaSeal
Find Relief From Varicose Veins VenaSeal Closure System Understand Varicose veins may be a sign of something more severe venous reflux disease. Your doctor can help you understand if you have this condition.
Compression Bandaging Formulary 2017
Area Drugs Therapeutics Committee Compression Bandaging Formulary 2017 Compression Bandaging Formulary 2017 Developed by the NHS Fife Wound and Skin Care Forum (WSCF) Group Approved: October 2017 Review:
Ustekinumab for the treatment of moderate to severe psoriasis
DOI: 10.3310/hta13suppl3/10 Health Technology Assessment 2009; Vol. 13: Suppl. 3 Ustekinumab for the treatment of moderate to severe psoriasis E Gospodarevskaya, J Picot, K Cooper, E Loveman* and A Takeda