COMETA trial suggests compression stockings after endothermal ablation advantageous in the short term


Roshan Bootun application of compression stockingsOutcomes of the COMETA (Compression following endothermal ablation) study were published in the February edition of Annals of Surgery. The results suggest that wearing compression stockings after endothermal ablation is “advantageous in the first few days after treatment” and is especially beneficial for those having concurrent phlebectomies.

First author Roshan Bootun (Imperial College London, London, UK) and colleagues write that the use of endovenous thermal ablation has increased in recent years and that it is now considered to be the “gold-standard” treatment for varicose veins. They describe the technique as “highly clinically- and cost-effective” and detail that it results in better quality of life outcomes for patients.

However, Bootun et al stress that post-intervention management—particularly in terms of postoperative compression—remains “unclear”. As a result, the investigators undertook a randomised study to investigate the effects of wearing compression stockings after varicose vein treatment.

The authors detail that 206 patients with saphenous vein reflux undergoing treatment with endothermal ablation (with or without concurrent phlebectomies) were randomised into two groups: one cohort of patients would receive seven days of compression stockings and the other would receive no stockings.

The primary outcome measure for the COMETA study was the pain score over the first 10 postoperative days, and patients were followed-up at two weeks and six months post-ablation.

Bootun and colleagues report the following key findings:

  • In the compression group, representing 49% of the total cohort, median pain score using a visual analogue scale was “significantly lower” on days two to five, compared to the no compression group
  • Those patents having concurrent phlebectomies and compression stockings also had significantly better pain scores on days one to three, day five, and day seven

Regarding other outcomes, Bootun et al note that improvement in the median venous clinical severity score was noted at six-month follow-up, but detail that this was “not significant”. They also report that no difference in the generic- or disease-specific quality of life was observed and that the time to return to activities was similar.

Finally, they detail that there were no differences in the degree of ecchymosis between the two groups and that both groups had similar occlusion rates.

Venous News first reported on these results following their presentation at the 2019 annual meeting of the American Vein and Lymphatic Society (AVLS; 7–10 November, Phoenix, USA).


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