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THE IMPACT OF THE ESCHAR TRIAL ON CLINICAL PRACTICE

• Published in: ANZ journal of surgery Vol. 77; no. s1; p. A100
• Main Authors: Warwick, A. M., Thomas, C., Dodd, P. D.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.05.2007
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/j.1445-2197.2007.04134_13.x

The ESCHAR trial, published June 2004, showed that patients with venous ulceration who had superficial or mixed superficial and segmental deep venous reflux had a decreased likelihood of recurrent ulceration if they were treated with superficial venous surgery. This prompted us, firstly, to review our service to see if we were following this level one evidence; secondly to estimate how many of our patients could benefit from adopting this practice. Method  Retrospective audit of all patients attending a nurse‐led ulcer clinic for a 6 month period between June and December 2004. Results  163 patients attended during the audit period. Data were retrieved for 146. Of these only 54 (37%) had purely venous ulceration on clinical assessment, of whom 31 had a venous duplex scan. 21 patients had superficial only, or mixed superficial and deep reflux; 8 had no reflux; 2 had deep reflux only. Of these 21 patients who could potentially be suitable for superficial venous surgery, 1 had deep venous occlusion, 4 patients refused surgery, 4 were considered unsuitable for surgery on medical grounds, 7 were not assessed for surgery, only 3 patients were awaiting superficial venous surgery. Conclusion  Despite the publication of evidence supporting superficial venous surgery in selected patients only 3/146 (2%) patients attending our clinic were listed for venous surgery. However 7/21 (33%) were not assessed for treatment. This study demonstrates the inertia in adopting “best evidence” into clinical practice. Even so the numbers of leg‐ulcer patients likely to benefit from surgery appears surprisingly small.