Cost-effectiveness analysis of current varicose veins treatments

Epstein, David; Bootun, Roshan; Diop, Modou; Ortega-Ortega, Marta; Lane, Tristan; Davies, AH

doi:10.1016/j.jvsv.2021.05.014

Cited by 24 publications

(16 citation statements)

References 93 publications

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“…Asymptomatic patients with varicose veins are initially managed with conservative treatment options that include medicine, compression therapy, and lifestyle modifications, while symptomatic patients are suggested to consider surgical options[ 1 ] that include endovenous laser ablation (EVLA), radiofrequency ablation (RFA), high ligation and stripping (HL/S) of the incompetent great saphenous vein (GSV), Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA), mechanochemical ablation (MOCA), cyanoacrylate embolization (CAE), etc. (Table 1 )[ 6 - 8 ].…”

Section: Strategies In Treatment Of Varicose Veins and Venous Insuffi...mentioning

confidence: 99%

“…Specifically, following general or lumbar anesthesia, an incision is made at the groin or upper calf, the GSV is located and incised, the proximal end is ligated below the SFJ, a stripping wire with a probe is put into the GSV and advanced distally, and the proximal part of the GSV is tied to the wire and stripped. Recently, a growing number of research data do not consistently favor surgery as the standard treatment option due to postoperative complications, and the 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy[ 8 , 16 - 18 ].…”

Section: Surgical Therapymentioning

confidence: 99%

Section: Surgical Therapymentioning

confidence: 99%

“…The surgical outcome of HL/S is relatively satisfactory; HL/S is associated with higher anatomic closure rates at 30 d and 5 years than RFA and ultrasound-guided foam sclerotherapy (UGFS)[ 8 , 16 ]. HL/S has similar long-term saphenous vein closure rates with EVLA at 5 years[ 8 , 16 - 18 ]. However, the postoperative complications are DVT, bleeding, hematoma, ecchymosis, wound infection, nerve injury, pain, and delayed return to normal activity.…”

Section: Surgical Therapymentioning

confidence: 99%

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Strategies and challenges in treatment of varicose veins and venous insufficiency

Gao¹,

Qian²,

Wang³

et al. 2022

WJCC

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Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.

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Section: Strategies In Treatment Of Varicose Veins and Venous Insuffi...mentioning

confidence: 99%

Section: Surgical Therapymentioning

confidence: 99%

Section: Surgical Therapymentioning

confidence: 99%

Section: Surgical Therapymentioning

confidence: 99%

See 2 more Smart Citations

Strategies and challenges in treatment of varicose veins and venous insufficiency

Gao¹,

Qian²,

Wang³

et al. 2022

WJCC

View full text Add to dashboard Cite

show abstract

“…For EVLA, the laser is converted into thermal energy through the optical fibre, which causes thermal injury to the target vein endothelium and its resultant occlusion 9. Both RFA and EVLA have shown good efficiency and high safety, whereas evidence indicates that EVLA is a more cost-effective therapeutic option 10 11…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of endovenous microwave ablation versus laser ablation for great saphenous vein varicosis: study protocol for a multicentre, randomised controlled non-inferiority trial

et al. 2022

BMJ Open

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IntroductionEndovenous microwave ablation (EMA) is a relatively novel thermal ablation treatment for great saphenous vein (GSV) varicosis, and its efficacy and safety are rarely reported. This study aims to explore whether EMA can be comparable to endovenous laser ablation (EVLA), which is a widely used thermal ablation treatment in clinical practice.Methods and analysisThis is a multicentre, randomised controlled non-inferiority trial to compare the efficacy and safety of EMA and EVLA in patients with GSV varicosis. We will recruit 180 patients in 6 centres and randomly assign them into treatment group (EMA group) and control group (EVLA group) in a 1:1 ratio. The patients will return to the hospitals at 7 days, 3 months, 6 months and 12 months, and will be called at 1 month after the treatment for follow-up visits. The primary outcome is the occlusion rate of GSV immediately, at 6 months, and at 12 months after the treatment. The secondary outcomes are Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) Score, operation time and instrument performance evaluation.Ethics and disseminationThis protocol has been approved by the Clinical Trial Ethics Committee of Beijing Hospital (2020BJYYEC-126–02), Peking Union Medical College Hospital (KS2020393), Beijing Tsinghua Changgung Hospital (No.20279-2-02), Beijing Luhe Hospital.Capital Medical University (2020-LHYW-030–01), the First Hospital of Hebei Medical University (No.2020249), and the First Affiliated Hospital of Xi’an Jiaotong University (XJTU1AF2021LSY-12). The trial results will be published in peer-reviewed journals.Trial registration numberNCT04726124.

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Pain Outcomes Following Mechanochemical Ablation vs Cyanoacrylate Adhesive for the Treatment of Primary Truncal Saphenous Vein Incompetence

et al. 2022

Self Cite

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IMPORTANCE Endovenous thermal ablations (ETAs) are recommended as first-line treatment for truncal vein reflux, have a short recovery time, and are cost-effective. However, ETAs are associated with discomfort during tumescent anesthesia infiltration. To minimize discomfort, nonthermal, nontumescent ablation techniques had emerged in the form of mechanochemical ablation (MOCA) and cyanoacrylate adhesive injection (CAE).OBJECTIVE To assess pain scores immediately after truncal ablation using a 100-mm visual analog scale and 10-point number scale to compare pain-related outcomes following mechanochemical ablation vs cyanoacrylate adhesive treatment. DESIGN, SETTING, AND PARTICIPANTSThe Multicenter Randomized II Clinical Trial Comparing Mechanochemical Ablation vs Cyanoacrylate Adhesive for the Treatment of Primary Truncal Saphenous Veins Incompetence study was a prospective multicenter randomized clinical trial conducted at 3 sites between November 2017 and January 2020. Inclusion criteria were primary great or small saphenous varicose veins; exclusion criteria included recurrent varicose veins, current deep venous thrombosis, or serious arterial disease. There were 392 participants screened, 225 were excluded, and 167 participants underwent randomization. Four participants did not receive allocated intervention and were included in the intention-to-treat analysis. Follow-up took place at 2 weeks, and 3, 6, and 12 months.INTERVENTIONS Patients with primary truncal vein incompetence were randomized to receive either MOCA or CAE. MAIN OUTCOMES AND MEASURESThe primary outcome measure was pain score immediately after completing truncal ablation using a 100-mm visual analog scale (VAS) and a 10-point number scale. Secondary outcome measures included degree of ecchymosis, occlusion rates, clinical severity, and generic and disease-specific quality of life (QoL) scores.RESULTS Of 167 study participants, 99 (59.3%) were women, and the mean (SD) age was 56 (15.8) years. Overall, 155 truncal veins treated (92.8%) were great saphenous veins. Demographic data and baseline status were comparable between treatment groups. A total of 73 patients (47%) underwent adjunctive treatment of varicosities. Overall median (IQR) maximum pain score after truncal treatment was 23 mm (10-44) on the VAS and 3 (2-5) on the number scale, showing no significant difference in median (IQR) pain measured by VAS (MOCA,] mm vs CAE, 20 [9.0-42.0] mm; P = .23) or by number scale (MOCA,(4)(5) vs CAE, 3 [2-4]; P = .18). Both groups demonstrated significant and comparable improvement in clinical severity, generic and disease-specific QoL scores, and complete occlusion rates. Four patients treated with CAE developed minor complications (superficial thrombophlebitis and thrombus extensions). CONCLUSIONS AND RELEVANCE To our knowledge, this was the first randomized clinical trial directly comparing nontumescent ablation techniques. The study demonstrated that the MOCA and CAE techniques have a similar periprocedural pain score. TRIAL REGISTRATION ClinicalTrial...

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Cost-effectiveness analysis of current varicose veins treatments

Cited by 24 publications

References 93 publications

Strategies and challenges in treatment of varicose veins and venous insufficiency

Strategies and challenges in treatment of varicose veins and venous insufficiency

Efficacy and safety of endovenous microwave ablation versus laser ablation for great saphenous vein varicosis: study protocol for a multicentre, randomised controlled non-inferiority trial

Pain Outcomes Following Mechanochemical Ablation vs Cyanoacrylate Adhesive for the Treatment of Primary Truncal Saphenous Vein Incompetence

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