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Randomized controlled trial of compression after endovenous thermal ablation of varicose veins (COMETA trial)

      Key Finding

      Patients undergoing endovenous thermal ablation for great or small saphenous vein reflux with concomitant phlebectomy who wore compression hose had lower pain scores in the first postoperative week.

      Study Summary

      The 206 patients in this prospective study were randomized to 1 week of stockings vs no stockings. One half of the patients were women, and the average age was ∼50 years. C2-C3 disease was present in 71% and C4-C5 disease in 29%. Pain and clinical scores were assessed at 2 weeks and 6 months after ablation. Patients who had undergone ablation plus phlebectomy and who had also worn compression stockings had better pain scores at 1 week. However, the differences were not statistically significant at 6 months. No differences were found in the ecchymosis rates, venous occlusion rates, interval to a return to usual activities, or quality of life scores between the two groups.

      Commentary

      Interesting that compression stocking did not show a difference in patients who had undergone ablation alone. They did show a benefit as an adjunct for pain control for those who had undergone phlebectomy in the same setting. This finding is consistent with the 2019 American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology guidelines, which recommend the use of compression after thermal ablation (grade 2C, weak recommendation, low-quality or very-low-quality evidence) but for an unspecified duration. In this study, most patients had stopped wearing their stockings (section titled “Compliance”) after 7 days. Perhaps most of the pain and discomfort had resolved within this period and the added discomfort from the stockings was prevalent. I have found that patients appreciate the support of compression stockings after ablation and phlebectomy compared with elastic bandages (ACE wraps; 3M Co, Saint Paul, Minn), which can bunch or slide, causing an almost tourniquet-like effect. However, a patient could experience difficulty in donning stockings over fresh phlebectomy incisions, depending on the extent of the procedure.