A network meta-analysis on the efficacy and safety of thermal and nonthermal endovenous ablation treatments

Bontinis, Vangelis; Bontinis, Alkis; Koutsoumpelis, Andreas; Chorti, Angeliki; Rafailidis, Vasileios; Giannopoulos, Argirios; Ktenidis, Kiriakos

doi:10.1016/j.jvsv.2023.03.011

Cited by 12 publications

(2 citation statements)

References 47 publications

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“…20 In another study by Bontinis et al, CAC displayed a decreased risk of post-procedural paresthesia and pigmentation, and induration compared with EVLA. 21, 22 In a study by Kubat E. et al, complications for CSV were evaluated. Nerve damage was found to be less in the CAC group compared to RFA and EVLA, and hyperpigmentation was more common in the EVLA group.…”

Section: Discussionmentioning

confidence: 99%

Complications of cyanoacrylate adhesive closure therapy in chronic venous insufficiency: A single center, single-surgeon study

Keleş

2023

Phlebology

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Objectives In this study, we present the complication data of patients we treated for chronic venous insufficiency (CVI) with cyanoacrylate adhesive closure (CAC) therapy for 2 years. Methods Complications of 382 CAC procedures performed by the same surgeon were reviewed retrospectively. Results Independent of patients, depending on the payment system of the state; two hundred twenty-three (58.4%) of 382 procedures were performed using the Venex system, and the Variclose system was used in 159 (41.6%) patients. A phlebitis-like reaction occurred in 46 (12%) patients, induration in 18 (4.7%) patients, hyperpigmentation in five (1.3%) patients, abscesses in four (1%) patients, cellulitis in three (0.8%) patients, and granuloma in one (0.3%) patient. In addition, as serious complications, deep vein thrombosis (DVT) developed in three patients and pulmonary embolism in one of these patients. Interestingly, temporary blindness was also observed in one patient. Conclusions Although CAC therapy is a reliable method, its complications should not be ignored. Its use by experienced surgeons reduces the risk of complications.

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Section: Discussionmentioning

confidence: 99%

Complications of cyanoacrylate adhesive closure therapy in chronic venous insufficiency: A single center, single-surgeon study

Keleş

2023

Phlebology

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“…35,36 Namely, findings from a recently published network meta-analysis comparing EVTA and NTNT ablation displayed a trend towards the superiority of EVTA (regarding occlusion success) when ablating larger GSV. 37 Considering the extensive use of endothermal ablation techniques and their well-known advantages over traditional surgery, the scarcity of high-quality data regarding the efficacy of EVTA in ablating large GSVs, came as a surprise to the authors of this review. Since the first publication on this subject dating back to the early 2000s, in a span of 20 years our research has failed to identify any randomized controlled trials investigating the impact of large GSVs (even GSVs over 10 mm) on EVTA outcomes.…”

Section: Discussionmentioning

confidence: 99%

Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression

Bontinis

Koutsoumpelis

et al. 2023

Vasc Med

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Background: We sought to assess the safety and efficacy of endovenous thermal ablation (EVTA) in treating large great saphenous veins (GSV) > 12 mm in diameter. Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 for comparative and noncomparative studies depicting EVTA in the treatment of GSV > 12 mm. Primary endpoints included GSV occlusion, technical success, deep vein thrombosis (DVT), and endovenous heat-induced thrombosis (EHIT). We conducted a comparative analysis between GSV > 12 mm and < 12 mm and a meta-regression analysis for two sets of studies, one including the whole dataset, containing treatment arms of comparative studies with GSV < 12 mm and one exclusively for GSV > 12 mm. Results: Seven studies, including 2564 GSV, depicting radiofrequency (RFA) and endovenous laser ablation (EVLA) were included. GSV > 12 mm occlusion, technical success, DVT, and EHIT estimates were 95.9% (95% CI: 93.6–97.8), 99.9% (95% CI: 98.9–100.0), 0.04% (95% CI: 0.0–3.4), and 1.6% (95% CI: 0.3–3.5). Meta-regression revealed a negative association between GSV diameter and occlusion for both the whole dataset ( p < 0.01) and the > 12 mm groups ( p = 0.04), GSV diameter and technical success for both groups ( p < 0.01), ( p = 0.016), and GSV diameter and EHIT only for the whole dataset ( p = 0.02). The comparative analysis between GSV < 12 mm and GSV > 12 mm displayed an occlusion estimate of OR 1.79 (95% CI: 1.25–2.56) favoring small GSV. Conclusion: Whereas we have displayed excellent occlusion and technical success results for the EVTA of GSV > 12 mm, our analysis has illustrated the unfavorable impact of GSV diameter on occlusion, technical success, and EHIT outcomes regardless of the 12 mm threshold. Potential parameter or device adjustments in a diameter-oriented fashion could further enhance outcomes.

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Sex/Gender Differences in Chronic Venous Disease

Han

2024

Sex/Gender-Specific Medicine in Clinical Areas

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A network meta-analysis on the efficacy and safety of thermal and nonthermal endovenous ablation treatments

Cited by 12 publications

References 47 publications

Complications of cyanoacrylate adhesive closure therapy in chronic venous insufficiency: A single center, single-surgeon study

Complications of cyanoacrylate adhesive closure therapy in chronic venous insufficiency: A single center, single-surgeon study

Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression

Sex/Gender Differences in Chronic Venous Disease

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