Editor's Choice – Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis

Hamann, Sterre A.S.; Giang, Jenny; Maeseneer, M. De; Nijsten, Tamar; Bos, R.R. van den

doi:10.1016/j.ejvs.2017.08.034

Cited by 112 publications

(78 citation statements)

References 33 publications

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“…Rates of 7-38 % have been reported for recurrent saphenofemoral incompetence detected with duplex ultrasound after high ligation and stripping, endovenous laser ablation (EVLA) or UGFS. The recurrence rate after high saphenofemoral ligation and stripping was significantly lower than after EVLA or UGFS (20).…”

Section: Definition Aetiology and Pathogenesis Of Recurrent Varicosmentioning

confidence: 72%

Therapie des inguinalen Crossenrezidivs: Ist die offene Re-Crossektomie noch zeitgemäß?

Gerontopoulou

Rass²

2019

Phlebologie

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Zusammenfassung Einleitung Die Rezidivvarikose ist trotz der Entwicklung neuer Verfahren und Operationsstrategien ein relevantes medizinisches Problem. Zur Therapie inguinaler Crossenrezidive (ICR) steht die offene Re-Crossektomie zur Verfügung, die derzeit gegenüber weniger invasiven Verfahren in den Hintergrund tritt. Methoden Diese Übersichtsarbeit basiert auf aktuell verfügbaren Leitlinien und einer Literaturrecherche bei PubMed zur Frage des Einsatzes und der Effektivität verschiedener Verfahren zur Therapie des ICR. Ergebnisse Inguinale Re-Crossektomie und Schaumsklerosierung sind uneingeschränkt anwendbar. Die Operation, sofern mit Barrieretechnik kombiniert, scheint langfristig effektiver als die Verödung und ist mit einer hohen Patientenzufriedenheit verbunden. Endovenös thermische Ablationsverfahren können für individuelle Fälle mit geeignetem anatomischem Befund eingesetzt werden. Vergleichende Studien fehlen. Schlussfolgerung Die offene Re-Crossektomie ist zeitgemäß. Ob der Vorteil der potentiell höheren Effektivität bei der Operation stärker wiegt als die geringere Invasivität der Schaumsklerosierung verbunden mit häufigeren Therapiesitzungen müsste mittels randomisierter kontrollierter Studien geklärt werden.

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Section: Definition Aetiology and Pathogenesis Of Recurrent Varicosmentioning

confidence: 72%

Therapie des inguinalen Crossenrezidivs: Ist die offene Re-Crossektomie noch zeitgemäß?

Gerontopoulou

Rass²

2019

Phlebologie

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“…This was taken into consideration in part by modifying the Cochrane risk of bias tool. 15 Some methodologies opted for an induction period to cater for the "learning curve" but others did not. 12,34 One major inconsistency was in the duration of procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Risk of methodological bias was explored using the Cochrane Risk of Bias tool for RCTs. 14,15 Quality assessment was performed using the Downs and Black quality assessment tool (for RCTs) and the National Heart, Lung and Blood Institute: Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group (NHLBI-QAT). 16,17…”

Section: Data Extractionmentioning

confidence: 99%

Efficacy of Cyanoacrylate Glue Ablation of Primary Truncal Varicose Veins Compared to Existing Endovenous Techniques: A Systematic Review of the Literature

Dimech

Cassar

2020

Surg J (N Y)

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Abstract Introduction One-third of adults in the United States and United Kingdom suffer from varicose veins. n-butyl-2-cyanoacrylate (NBCA) glue is a novel endovascular, nontumescent, nonthermal ablation technique for treatment of this condition. It has proved effective in multiple studies since its first use in 2013. The aim of this systematic review is to assess the efficacy of NBCA in ablating primary truncal varicose veins and eliminating reflux compared with existing endovascular techniques. Secondary outcomes include complications and quality of life. Methods PRISMA was used as a guide and studies were screened for risk of bias and methodological quality. Subjects had to be ≥18 years of age and followed-up posttreatment with color Duplex ultrasound (DUS). Eligibility criteria included saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ) incompetence with reflux down truncal veins lasting >0.5 seconds on DUS interrogation and a Clinical, Etiological, Anatomical, and Pathophysiological classification of venous disorders ranging between C1 and C6. Results Out of 2,910 patients (3,220 veins) in 17 studies, 1,981 were administered NBCA, 445 radiofrequency ablation (RFA), and 484 endovenous laser ablation (EVLA) with mean procedure times of 25.7, 23.2, and 28.7 minutes, respectively. Mean recruitment period was 9 months (1–36 months) and followed-up for an average of 12.3 months (1–36 months). The majority were C2 to C3. Two-year occlusion rates were 93.7, 90.9, and 91.5% for NBCA, RFA, and EVLA, respectively. NBCA-treated patients experienced the least complications, with bruising, phlebitis, and pain being the most prevalent. Quality of life improved equally in all three modalities. Conclusion NBCA is simple to administer, safe, and effective even without compression stockings. Further studies are required to assess longer-term benefit and the effect of anticoagulation on vein obliteration.

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“…Die Definitionen eines anatomischen Erfolgs der Behandlung variieren von Verschluss, Obliteration, Kompetenz der Vene, ohne Reflux, ohne Rekanalisierung und Teilobliteration mit antegradem Flow [40,41].…”

Section: Ergebnisse Der Evla-behandlungunclassified

Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

2020

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The results of studies on treatment of the great saphenous vein (GSV) with sapheno-femoral-junction (SFJ) insufficiency are unclear. Guidelines, however, recommend endovenous laser ablation (EVLA) and ultrasound-guided-foamsclerotherapy (UGFS) for symptomatic varicose large saphenous vein. There are numerous studies on GSV treatment but only a few randomized studies with a follow-up of two years and more. Meta-analyses in most instances included all studies and do not focus on studies with a follow-up of two years and longer. Methods A literature research in Pubmed used the keyword “great saphenous vein treatment”, “large saphenous vein treatment”, “varicose therapy” in conjunction with “randomized controlled trial”, “meta-analysis” and “systematic review”. Of 128 studies only 24 randomized controlled studies investigated the effect of High Ligation and Continuous Stripping (HL + CS), Endovenous Laser Ablation (EVLA), Radiofrequency Ablation (RFA), Liquid Sclerotherapy (LS), and Ultrasound-Guided-Foam-Sclerotherapy (UGFS) and a follow-up of two and more years. Study evaluation included “reflux”, “recurrence”, “therapy technique”, numbers of patients/legs treated, length of follow-up, and primary/secondary study endpoints. Results Most of these studies investigated surgical High Ligation and Continuous Stripping (HL + CS) with a follow-up of two years and more. This technique served a reference technique for other techniques in randomized controlled studies. However, there are major differences in techniques, mode of treatment, definitions, criteria for exclusion and inclusion, and study endpoints.The surgery study group included 1915 legs in 19 studies, the EVLA group 1047 legs in 12 studies and 240 legs in 3 studies with combined HL + EVLA treatment. RFA was used in 299 legs in 4 studies, UGFS in 661 legs in 5 studies, combined UGFS + HL in 39 legs and LS + HL in 92 legs in one study each.EVLA is associated with more reflux and recurrence when compared to HL + CS. RFA shows similar reflux and recurrence rates as surgery. In most studies UGFS and LS is followed by more reflux and recurrence when compared to surgery. Conclusion Due to heterogeneity of studies comparing study results of HL + CS, EVLA, RFA, LS and UGFS is not reliable. UIP or ECOP may form a commission to establish uniform, reliable and accepted study designs for varicose vein treatment to improve comparability of further randomized studies.

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Editor's Choice – Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis

Abstract: EVLA and HL+S show higher success rates than UGFS 5 years after GSV treatment. Recurrent reflux rates at the SFJ were significantly lower in HL+S than UGFS and EVLA. VCSS scores were similar between EVLA and HL+S.

Cited by 112 publications

References 33 publications

Therapie des inguinalen Crossenrezidivs: Ist die offene Re-Crossektomie noch zeitgemäß?

Therapie des inguinalen Crossenrezidivs: Ist die offene Re-Crossektomie noch zeitgemäß?

Efficacy of Cyanoacrylate Glue Ablation of Primary Truncal Varicose Veins Compared to Existing Endovenous Techniques: A Systematic Review of the Literature

Treatment of varicose great saphenous veins with saphenofemoral junction insufficiency – what is the evidence? *

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