Randomized controlled trial of compression after endovenous thermal ablation of varicose veins (COMETA Trial)
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background: The 21st century has witnessed a rise in the use of endovenous
thermal ablation. Being highly clinically and cost-effective and improving the
quality of life of patients, they are now considered to be the ‘‘gold-standard’’
treatment for varicose veins. Post-intervention management, especially in
terms of postoperative compression, however, remains unclear. As a result, a
randomized study was undertaken to investigate the effects of wearing
compression stockings after varicose vein treatment.
Method: Patients with saphenous vein reflux undergoing treatment with
endothermal ablation (with or without concurrent phlebectomies) were
randomized to receive either 7 days of compression stockings or no stockings.
The primary outcome measure for this study was the pain score over the first
10 postoperative days. The pain scores, clinical score, time to return to normal
activities, and ecchymosis were assessed. Patients were followed-up at
2 weeks and 6 months post-ablation.
Results: In total, 206 patients were randomized, 49% of them to the
compression group. The mean age was 49.7 (16) years and approximately
51% of the population was male. The median pain score in the compression
group using a visual analog scale was significantly lower on days 2–5,
compared to the no compression group. Those having concurrent phlebectomies and compression stockings also had significantly better pain scores on
days 1–3, day 5, and day 7. Improvement in the median venous clinical
severity score was noted at 6-month follow-up, but this was not significant. No
difference in the generic- or disease-specific quality of life was observed and
the time to return to activities was similar. There were no differences in the
degree of ecchymosis between the 2 groups and both groups had similar
occlusion rates.
Conclusions: These results indicate that wearing compression stockings after
endothermal ablation is advantageous in the first few days after treatment and
is especially beneficial for those having concurrent phlebectomies.
thermal ablation. Being highly clinically and cost-effective and improving the
quality of life of patients, they are now considered to be the ‘‘gold-standard’’
treatment for varicose veins. Post-intervention management, especially in
terms of postoperative compression, however, remains unclear. As a result, a
randomized study was undertaken to investigate the effects of wearing
compression stockings after varicose vein treatment.
Method: Patients with saphenous vein reflux undergoing treatment with
endothermal ablation (with or without concurrent phlebectomies) were
randomized to receive either 7 days of compression stockings or no stockings.
The primary outcome measure for this study was the pain score over the first
10 postoperative days. The pain scores, clinical score, time to return to normal
activities, and ecchymosis were assessed. Patients were followed-up at
2 weeks and 6 months post-ablation.
Results: In total, 206 patients were randomized, 49% of them to the
compression group. The mean age was 49.7 (16) years and approximately
51% of the population was male. The median pain score in the compression
group using a visual analog scale was significantly lower on days 2–5,
compared to the no compression group. Those having concurrent phlebectomies and compression stockings also had significantly better pain scores on
days 1–3, day 5, and day 7. Improvement in the median venous clinical
severity score was noted at 6-month follow-up, but this was not significant. No
difference in the generic- or disease-specific quality of life was observed and
the time to return to activities was similar. There were no differences in the
degree of ecchymosis between the 2 groups and both groups had similar
occlusion rates.
Conclusions: These results indicate that wearing compression stockings after
endothermal ablation is advantageous in the first few days after treatment and
is especially beneficial for those having concurrent phlebectomies.
Date Issued
2021-02-01
Date Acceptance
2019-09-07
Citation
Annals of Surgery, 2021, 273 (2), pp.232-239
ISSN
0003-4932
Publisher
Ovid Technologies (Wolters Kluwer Health)
Start Page
232
End Page
239
Journal / Book Title
Annals of Surgery
Volume
273
Issue
2
Copyright Statement
© 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. This is the pre-peer reviewed version of the article, which has been published in final form at https://dx.doi.org/10.1097/sla.0000000000003626
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://insights.ovid.com/crossref?an=00000658-900000000-94733
Grant Number
RDB04 79560
RD207
Subjects
Surgery
11 Medical and Health Sciences
Publication Status
Published
Date Publish Online
2019-12-16