Systematic review of compression following treatment for varicose veins

El-Sheikha, Joseph; Carradice, Daniel; Nandhra, Sandip; Leung, Clement; Smith, George E.; Campbell, Bruce; Chetter, Ian

doi:10.1002/bjs.9788

Cited by 46 publications

(40 citation statements)

References 31 publications

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“…60 This should always be considered in cases of leg ulcers that are associated with varicose disease. 74 Even though use of stockings in the postoperative period has been recommended by some authors, 63 the effectiveness of this intervention was not found to be superior over the short term (seven days) or medium term (three weeks). 62 Regarding the implications for practice of our analysis, the important question to be formulated is how much longer should be waited before the paradigms for varicose vein treatment are changed.…”

Section: Discussionmentioning

confidence: 97%

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Evidence for varicose vein treatment: an overview of systematic reviews

et al. 2018

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Section: Discussionmentioning

confidence: 97%

“…El-Sheikha et al, 63,64 no meta-analysis could be conducted because of substantial heterogeneity. Overall, the quality of evidence was either considered low or was not appraised.…”

Section: Any Postoperative Intervention: Postoperative Compressionmentioning

confidence: 99%

Evidence for varicose vein treatment: an overview of systematic reviews

et al. 2018

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“…While external pressure applied at the time of procedure may be beneficial, 24 the role of compression post thermal ablation has not been established. 25 A RCT in patients with GSV incompetence not associated with ulceration, who were treated with EVLT, favoured a minimum 48 h compression therapy duration, although the greatest benefit was achieved with one week of compression. 26 It may be said that the improvement in symptoms noted with four hours, 48 h, or one week compression therapy is part of the natural healing process independent of duration of compression.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial☆

Onwudike

Abbas

Thompson

et al. 2020

European Journal of Vascular and Endovascular Surgery

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This study examined the effect of post-procedure leg compression in a full range of patients with superficial truncal incompetence treated exclusively with radiofrequency ablation (RFA). There was no significant difference in the target vein occlusion rate, quality of life, venous clinical severity score, patient satisfaction, and pain score with or without compression. This study provides further evidence that varicose vein patients undergoing RFA may not require post-procedure compression. Objective: Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). Methods: This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. Results: In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2eC6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n ¼ 47) and 98% (n ¼ 45), respectively (p ¼ 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference À1, 95% CI À2 e 3, p ¼ .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI À1 e 2, p ¼ .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p ¼ .72) and pain score 2.0 vs. 2.0 (p ¼ .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p ¼ 1.0 for above the knee and p ¼ 1.0 for below the knee). Conclusion: The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.

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“…Compression post endovenous laser ablation for the treatment of varicose veins has been reported to reduce pain and improve function [ 20 ]; however there is little evidence upon which to base recommendations regarding the usage of compression stockings [ 21 ]. Although the use of compression post endovenous laser ablation has been reported in children, it was used for a short period of only 5 days post endovenous laser ablation [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Endovenous laser ablation therapy in children: applications and outcomes

et al. 2017

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BackgroundEndovenous laser ablation is well recognized as the first-line treatment for superficial venous reflux with varicose veins in adults. It is not widely reported and is not an established practice in pediatric patients.ObjectiveTo illustrate a variety of pediatric venous conditions in which endovenous laser ablation can be utilized and to demonstrate its feasibility and safety in children.Materials and methodsWe conducted a retrospective review of endovenous laser ablation procedures performed between January 2007 and July 2014 at two large pediatric institutions.ResultsWe included 35 patients (17 males) who underwent endovenous laser ablation to 43 veins. Median age at first treatment was 14 years (range: 3–18 years). Median weight was 56 kg (range: 19–97 kg). Underlying diagnoses were common venous malformation (15), Klippel–Trenaunay syndrome (8), superficial venous reflux with varicose veins (5), verrucous hemangioma-related phlebectasia (4), venous varix (2) and arteriovenous fistula (1). The most common aim of treatment was to facilitate sclerotherapy. Thirty-four patients had treatment in the lower limbs and one patient in an upper limb. Ten of the veins treated with endovenous laser ablation had an additional procedure performed to close the vein. Complications attributable to endovenous laser ablation occurred in two patients (6%). One patient experienced post-procedural pain and one patient developed a temporary sensory nerve injury. Median clinical follow-up was 13 months (range: 28 days–5.7 years). The aim of the treatment was achieved in 29 of the 35 (83%) patients.ConclusionEndovenous laser ablation is technically feasible and safe in children. It can be used in the management of a range of pediatric venous diseases with good outcomes.

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Systematic review of compression following treatment for varicose veins

Abstract: There is currently little quality evidence upon which to base any recommendations concerning compression following treatment for varicose veins.

Cited by 46 publications

References 31 publications

Evidence for varicose vein treatment: an overview of systematic reviews

Evidence for varicose vein treatment: an overview of systematic reviews

Editor's Choice – Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial☆

Endovenous laser ablation therapy in children: applications and outcomes

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