Optimum Duration of Compression Stockings After Endovenous Varicose Vein Surgery
Optimum Duration of Compression Stockings After Endovenous Varicose Vein Surgery
Compression stockings are traditionally worn for a period of time after varicose vein surgery
 to reduce pain and bruising. The investigators provide an ambulatory endovenous ablation
 service. Patients come to the Veins Unit, receive oral sedation, have their veins treated
 with either laser or radiofrequency ablation plus phlebectomies* under local anaesthetic,
 recover for an hour and then go home. *Phlebectomy describes the technique of pulling out
 small varicose veins through small incisions in the overlying skin. The standard practice of
 the Veins Unit is to advise patients to wear class two compression stockings for four weeks
 post-operatively. Many patients would prefer a shorter period of time in stockings.

 The Nice Guidelines for Varicose Veins has posed the question: 'How long should stockings be
 worn for after endovenous ablation?'

 Three trials have addressed this issue:

 Bakker looked at patients who wore stockings for either two or seven days after laser
 ablation only; the group who wore stockings for seven days fared better.

 Elderman looked at patients who either wore no stockings or stockings for two weeks after
 laser ablation only; the group who wore stockings for two weeks had less pain.

 Krasznai looked at patients who wore stockings for either 4 hours or 72 hours after
 radiofrequency ablation only; there was no significant difference in post-op pain among
 groups.

 None of these trials included patients who had phlebectomies at the same time. This study
 aims to answer the question 'How long is it necessary to wear compression stockings for after
 endovenous ablation (either laser or radiofrequency) plus concomitant phlebectomies?' The
 investigators plan to divide 110 patients into two groups- either 'stockings for 2 weeks'
 (trial group) or 'stockings for 4 weeks' (usual treatment group).

 Pre-operatively, all patients will fill out a pain score and two short quality of life
 questionnaires, one specific to varicose veins. Post-operatively at home, all patients will
 be asked to keep a diary of pain and analgesia use. They will also document bruising at seven
 days on charts and on a visual scale. At their four week clinic review, all patients will be
 asked to fill out a pain and bruising score, a bruising chart and the two short quality of
 life questionnaires again.

 The group with the best pain, bruising and quality of life scores post-operatively will help
 guide duration of compression therapy for future patients.
The Nice Guidelines for Varicose Veins, published by the NHS in 2013, questioned the clinical
 benefit of stockings after endovenous ablation, and if there is benefit, how long the
 stockings should be worn for.

 Three randomised controlled trials have addressed these issues:

 Bakker and colleagues randomised 69 patients into two groups- stockings were worn for either
 two or seven days after laser ablation. The group who wore stockings for seven days had
 better pain and quality of life scores.

 Elderman and colleagues randomised 111 patients who had laser ablation into two groups- a
 group who wore no stockings, or a group who wore stockings for two weeks. The group who wore
 stockings for two weeks had less pain and required less analgesia.

 Krasznai and colleagues randomised 101 patients into two groups- stockings were worn for
 either 4 hours or 72 hours after radiofrequency ablation only; there was no significant
 difference in post-op pain among groups.

 None of these trials included patients who had phlebectomies at the same time.

 This study hopes to answer the question 'How long is it necessary to wear compression
 stockings for after endovenous ablation (either laser or radiofrequency) plus concomitant
 phlebectomies?'

 110 consecutive patients will be randomised into 'stockings for 2 weeks' (trial group) or
 'stockings for 4 weeks' (usual treatment group). Randomisation will be facilitated by online
 random number generation (https://www.random.org/). Patients with odd numbers will be
 allocated into the trial group; those randomly assigned even numbers will be allocated into
 the usual treatment group.

 Pre-operatively, all patients will be asked to fill out a visual analog pain score (VAS), the
 Aberdeen Varicose Veins questionnaire and the RAND 36-Item Health Survey. Patients will be
 evaluated in terms of CAEP staging and the Venous Clinical Severity Score (VCSS) by the
 supervising nurse or physician.

 Endovenous laser therapy (EVLT) plus phlebectomies or radiofrequency ablation (RFA) plus
 phlebectomies will be performed in the standard manner.

 The trial group will wear the stockings for 24 hours a day for the first 4 days, and then
 during the day only for the next 10 days. The usual treatment group will wear the stockings
 for 24 hours a day for a week, and then during the day only for the next 3 weeks.

 Post-operatively at home, patients will be asked to keep a diary of pain and analgesia use.
 They will also document bruising at 7 days on a diagram and on a visual analog scale.

 At their 4 week clinic review, again the VCSS will completed and patients will be asked to
 fill out a visual analog pain and bruising score, a bruising diagram, the Aberdeen Varicose
 Veins questionnaire and the RAND 36-Item Health Survey.

 Primary outcome measures are post-operative pain scores on the visual analog scale and
 post-operative bruising scores on the visual analog scale.

 Secondary outcome measures are changes in veins-related quality of life measured on the
 Aberdeen Varicose Veins Questionnaire and changes in overall quality of life based on the
 RAND 36-Item Health Survey.
Inclusion Criteria:

 -  Primary or recurrent varicose veins

 -  Diagnosis on duplex of truncal (GSV and/or SSV and/or AATV) insufficiency

 -  Must be able to provide informed consent

 Exclusion Criteria:

 -  Patients who require long term compression (active ulcers/ deep venous incompetence)

 -  Patients who have already had one leg enrolled in the study

 -  Patients with congenital venous malformations

 -  Patients who require avulsions only

 -  Patients who are unable to complete the questionnaires due to a lack of command over
 the language or who have vision/ hearing disabilities

 -  Patients who are unable to attend the hospital for follow-up