***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Venous leg ulcers account for 85 % of all lower-extremity ulcers , with treatment costs of 3 billion dollars and loss of 2 million workdays per year . The purpose of this study was to vali date the clinical efficacy and cost effectiveness of multidisciplinary guidelines for the diagnosis and treatment of venous leg ulcers . METHODS Eighty ( 40 retrospective , 40 prospect i ve ) patients from the United States and United Kingdom were enrolled . RESULTS United States patients were 6.5 times and United Kingdom 2 times more likely to heal if a guideline was followed ( P < 0.001 ) . A significant decrease was noted in healing time for both the United States and United Kingdom ( P < 0.01 ) , and the median cost decreased significantly when the guideline was followed ( P < 0.01 ) . CONCLUSIONS Implementation of a guideline for diagnosis and treatment of venous leg ulcers result ed in improvement in diagnosis , decrease in healing time , and an increase in healing rates result ing in lower costs AIM The aim of this study was to review published literature concerning the use of compression treatments in the management of venous and lymphatic diseases and establish where reliable evidence exists to justify the use of medical compression and where further research is required to address areas of uncertainty . METHODS The authors search ed medical literature data bases and review ed their own collection s of papers , monographs and books for papers providing information about the effects of compression and r and omized clinical trials of compression devices . Papers were classified in accordance with the recommendations of the GRADE group to categorize their scientific reliability . Further classification was made according to the particular clinical problem that was addressed in the papers . The review included papers on compression stockings , b and ages and intermittent pneumatic compression devices . RESULTS The International Compression Club met once in Vienna and corresponded by email in order to reach an agreement of how the data should be interpreted . A wide range of compression levels was reported to be effective . Low levels of compression 10 - 30 mmHg applied by stockings are effective in the management of telangiectases after sclerotherapy , varicose veins in pregnancy , the prevention of edema and deep vein thrombosis ( DVT ) . High levels of compression produced by b and aging and strong compression stockings ( 30 - 40 mmHg ) are effective at healing leg ulcers and preventing progression of post-thrombotic syndrome as well as in the management of lymphedema . In some areas no reliable evidence was available to permit recommendations of level of compression or duration of treatment . These included : management of varicose veins to prevent progression , following surgical treatment or sclerotherapy for varicose veins , and the level of compression required to treat acute DVT . CONCLUSION This review shows that whilst good evidence for the use of compression is available in some clinical indications , there is much still to be discovered . Little is know about dosimetry in compression , for how long and at what level compression should be applied . The differing effects of elastic and short-stretch compression are also little understood This study compared the rate of leg ulcer recurrence using two types of compression stockings  and examined the factors underlying Endovenous laser ablation ( EVLA ) is a popular minimally invasive treatment for  varicose veins .  Surgical treatment , featuring junctional ligation and inversion stripping , has shown excellent clinical and cost effectiveness . The clinical effectiveness of both treatments was compared within a r and omized trial OBJECTIVES To assess the influence of a vascular-led community service on the outcome of chronic leg ulcers .  DESIGN Before and after study . METHOD Healing and recurrence were compared between ulcerated limbs ( n = 149 ) from a r and om sample of 200 patients treated in the community and consecutive limbs ( n = 200 ) from 180 patients treated in specialised clinics . In these clinics , vascular disease was routinely identified with venous duplex and ankle-brachial pressure index . Surgery was offered if superficial vein reflux alone was detected . Compression b and aging was applied to limbs with ABPI > 0.85 . Healed limbs were treated with compression hosiery . RESULTS After the clinics were introduced , the 12 and 24-week healing rates increased from 12 and 29 per cent to 53 and 68 per cent respectively ( p < 0.01 ) , and the 6 and 12 month recurrence rates decreased from 43 and 54 per cent to 21 and 23 per cent respectively ( p < 0.01 ) . Superficial venous surgery reduced recurrence at 1 year to 9 per cent . CONCLUSION Outcome of leg ulcers is improved in a vascular-led community service . Routine surgical correction , in cases of reflux limited to the superficial system , may further reduce the chance of recurrence This report describes the clinical effectiveness and recurrence rates from a r and omized trial of endovenous laser ablation ( EVLA ) and surgery for varicose veins Endovenous laser ablation ( EVLA ) is a minimally invasive technique for treating varicose veins due to truncal vein incompetence . This r and omized trial compared EVLA with  conventional surgery  in patients with primary saphenofemoral and great saphenous vein ( GSV ) reflux The aim of this study was to estimate costs of treating venous leg ulcers in Sweden and the United Kingdom during 1 year and to quantify costs in different health states . The costs of treating four different types of venous leg ulcers were estimated for 52 weeks by a stochastic health economic model , which simulated re source use data obtained from prospect ively collected patient data , expert panels in the two countries , and published scientific literature . The average cost of treating an ulcer varied between 1332 Euro and 2585 Euro in Sweden and from 814 Euro to 1994 Euro in the United Kingdom . Cost of treating large ulcers  ( > /= 10 cm(2 ) ) of long duration ( > /= 6 months ) was highest in both countries . Frequency of dressing changes and duration of time for each dressing change were higher in Sweden than in the United Kingdom , result ing in higher total cost per patient in Sweden . An important factor for the total costs was time to heal . Other important variables influencing treatment costs were frequency and duration of dressing changes . Actions to reduce time used for dressing changes and the total time to healing are thus very important in reducing costs spent on treatment of venous leg ulcers in both countries BACKGROUND Conventional saphenous vein stripping is difficult to be indicated for the treatment of varicose veins in patients classified as CEAP C4 , C5 , or C6 . OBJECTIVE This study was developed to evaluate treatment results for varicose veins with active ulcers using endovenous laser ( EVL ) , compared to a group undergoing clinical treatment , during 1 year . PATIENTS AND METHOD Fifty-two patients presenting with varicose veins with active ulcers for more than 1 year were divided for treatment into two r and omized groups : Group 1 , clinical treatment , composed of 25 subjects , was su bmi tted to elastic or inelastic compression therapy ; Group 2 , EVL treatment , composed of 27 subjects , was su bmi tted to great and or small saphenous vein ablation with a 980-nm diode EVL , plus the clinical treatment .  Intravenous and perivenous temperatures were measured continuously during the EVL treatment . All patients were followed for 12 months and studied with ultrasound at the beginning and end of the study . The ulcers ' areas were evaluated initially and at every 3 months . RESULTS In 12 months , 81.5 % of the wounds in patients in Group 2 and only 24 % in patients in Group 1 had healed . Ulcer recurrence rate was 44.4 % in Group 1 . The mean wound area in Group 1 decreased from 17.48 to 12.76 cm2 at the end of the year . In Group 2 , the wound area decreased from 22.26 to 2.7 cm2 ( p=.0037 ) . Mean intravenous and perivenous temperatures of 79.3 and 43.0 ° C were recorded . CONCLUSION The treatment for varicose veins with EVL is safe in patients with active ulcers . Wounds healed faster than in patients undergoing clinical treatment alone during a 1-year period . There was no ulcer recurrence in patients treated with EVL OBJECTIVE This prospect i ve study investigated the cost and efficacy of leg ulcer care over a three-month period during 1993 , 1994 and 1999 . It compared two health authorities ( Stockport and Trafford ) whose population s totalled 540,000 . METHOD All patients with active leg ulcers were invited to  community leg ulcer clinics offering research -based innovations in care .  Patients without significant arterial disease ( ankle brachial pressure index less than 0.8 ) were treated with multilayer compression b and aging . RESULTS The 42 % healing rate reported in the original Stockport study was maintained at 40 % in 1999 , although the 65 % healing rate achieved by the leg ulcer clinics in 1993 was not replicated , with rates falling to 46 % . Following the opening of community leg ulcer clinics in Trafford , healing rates rose from 20 % to 42 % . The annual expenditure on leg ulcer care in Stockport increased from 65,545.56 Pounds to 83,344.30 Pounds , while in Trafford the cost of care dropped from 151,375.35 Pounds to 53,176.76 Pounds between 1994 and 1999 . CONCLUSION This study suggests that reductions in costs and improvements in healing rates can be sustained in a mature community leg ulcer clinic programme staffed by specialist leg ulcer nurses Endovenous laser therapy ( EVLT ) is a minimally invasive treatment for varicose veins . This study compares early quality -of-life ( QoL ) outcomes following EVLT and surgery .  Two nonr and omized groups were studied : an EVLT group with 70 patients , median age 49 ( interquartile range [ IQR ] 35 - 58 ) years , and a surgery group with 62 patients , median age 49 ( IQR 35 - 61 ) years . Patients were assessed prior to and at 1 , 6 , and 12 weeks following the procedure using the Short Form 36 ( SF-36 ) , the Aberdeen Varicose Veins Question naire ( AVVQ ) , and the Venous Clinical Severity Score ( VCSS ) . Follow-up at 1 , 6 , and 12 weeks was 100 % , 77 % , and 70 % following EVLT and 100 % , 85 % , and 47 % following surgery . SF-36 scores were significantly better in the EVLT group at 1 week ( Physical Functioning , Role Physical , Bodily Pain , Vitality , and Social Functioning domains ) and at 6 weeks ( Physical Functioning and Role Physical ) . At 12 weeks , no significant differences were evident between the groups . AVVQ scores were significantly better in the EVLT group at 6 and 12 weeks . VCSS scores were significantly improved in both groups at 12 weeks . EVLT and surgery provide similar QoL improvements in patients with varicose veins .  EVLT , however , removes the QoL limitations experienced by patients in the early postoperative period BACKGROUND Chronic venous leg ulceration can be managed by compression treatment , elevation of the leg , and exercise . The addition of ablative superficial venous surgery to this strategy has not been shown to affect ulcer healing , but does reduce ulcer recurrence . We aim ed to assess healing and recurrence rates after treatment with compression with or without surgery in people with leg ulceration . METHODS We did venous duplex imaging of ulcerated or recently healed legs in 500 consecutive patients from three centres . We r and omly allocated those with isolated superficial venous reflux and mixed superficial and deep reflux either compression treatment alone or in combination with superficial venous surgery . Compression consisted of multilayer compression b and aging every week until healing then class 2 below-knee stockings . Primary endpoints were 24-week healing rates and 12-month recurrence rates . Analysis was by intention to treat . FINDINGS 40 patients were lost to follow-up and were censored . Overall 24-week healing rates were similar in the compression and surgery and compression alone groups ( 65 % vs 65 % , hazard 0.84 [ 95 % CI 0.77 to 1.24 ] ; p=0.85 ) but 12-month ulcer recurrence rates were significantly reduced in the compression and surgery group ( 12 % vs 28 % , hazard -2.76 [ 95 % CI -1.78 to -4.27 ] ; p<0.0001 ) . Adverse events were minimal and about equal in each group . INTERPRETATION Surgical correction of superficial venous reflux reduces 12-month ulcer recurrence . Most patients with chronic venous ulceration will benefit from the addition of simple venous surgery OBJECTIVES To compare the clinical and cost-effectiveness of two different compression b and ages for the healing of  venous leg ulcers .  DESIGN A pragmatic , r and omised controlled trial with an economic evaluation . SETTING Community , district nurse-led services ; community leg ulcer clinics ; hospital leg ulcer clinics with community outreach . A range of urban and rural setting s in Engl and and Scotl and . PARTICIPANTS Patients with a venous leg ulcer of at least 1-week 's duration , at least 1 cm in length or width and an ankle : brachial pressure index of at least 0.8 . INTERVENTIONS The four-layer b and age ( 4LB ) ( 
    Output:
    
There is an absence of evidence regarding the effects of superficial endovenous thermal ablation on ulcer healing , recurrence or quality of life of people with venous leg ulcer disease .