Published in:
01-12-2022 | Leg Ulcer | Study protocol
Axial ablation versus terminal interruption of the reflux source (AAVTIRS): a randomised controlled trial
Published in: Trials | Issue 1/2022
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Background
Treatment of superficial venous reflux has been shown to improve ulcer healing time and reduce the risk of ulcer recurrence. Terminal ablation of the reflux source (TIRS) is an alternative to formal endovenous ablation or surgery which can be performed by injecting sclerosant foam into the peri-ulcer plexus of the veins. TIRS has been shown to be successful and in our experience is the option preferred by many patients, when offered as an alternative to axial ablation (AA).
Aim
To determine if the proportion of ulcers healed within 6 months of endovenous treatment differs between patients undergoing AA of varicose veins or TIRS by peri-ulcer foam sclerotherapy.
Methods
AAVTIRS is an assessor-blinded randomised controlled trial. Patients will be recruited from a dedicated ulcer clinic in Roscommon University Hospital and from the vascular surgical clinics in University Hospital Galway. All patients attending the ulcer clinic will be screened for eligibility.
Randomisation
Random computer-generated sequence is stratified by ulcer size. Allocation will be concealed using sealed opaque envelopes.
Blinding
Assessors reviewing wounds at follow -p visits will be blinded to patient allocation.
Primary endpoint
The proportion of ulcers healed within 6 months of enrolment.
Discussion
This will be the first time that TIRS has been evaluated with a properly powered randomised trial in the setting of venous ulcer management. Streamlining the management of venous ulcers has broad health economic benefits. If it is found that TIRS is superior or non-inferior to AA, then a less expensive, less invasive injection can be offered as an alternative to AA in an attempt to encourage the healing of venous ulcers. If AA is found to be superior to TIRS, then this would suggest that all patients undergoing ablation in the management of venous ulcers should have their superficial reflux fully treated, building on the evidence of the EVRA trial.
Trial registration
ClinicalTrials.gov NCT04484168. Registered on 23 July 2020