Treatment of Varicose Veins: The Present and the Future – A Questionnaire Survey

Abstract

INTRODUCTIONThe treatment options for varicose veins have increased over the last few years. Despite al ack of randomised trials comparing the various modalities, many surgeons are changing their practice. The aim of this study was to assess the current practice of surgeons in Great Britain and Ireland.MATERIALS AND METHODS Ap ostal questionnaire survey was sent to surgical members of the Vascular Society of Great Britain and Ireland and the Venous Forum of The Royal Society of Medicine. Of 561 questionnaires sent, 349 were returned completed (62%). RESULTS The types of varicose vein treatments offered by each surgeon varied widely in both NHS and private practice. The vast majority (96%) offered conventional surgery (CS) on the NHS. Foam sclerotherapy (FS) endovenous laser (EVL) and radiofrequency ablation (RF) were more likely to be offered in private practice than in NHS practice. Overall, 38% of respondents for NHS practice and 45% of respondents for private practice offered two or more modalities. Of the respondents who were not yet performing FS, EVL, or RF,1 9% were considering or had undertaken training in FS, 26% in EVL and 9% in RF. When asked to consider future practice, 70% surgeons felt that surgery would remain the most commonly used treatment. This was followed by FS (17%), EVL (11%) and RF (2%).CONCLUSIONS Over one-third of respondents are now offering more than one treatment modality for the treatment of varicose veins. Whilst there is movement towards endovascular treatments, the problem of cost has yet to be solved. At present, surgery remains the most popular modality in both the NHS and private practice; however,i mproved outcomes and patient preference may lead to ac hange in practice. WINTERBORNC ORBETT TREATMENT OF VARICOSE VEINS: THE PRESENT AND THE FUTURE -AQ UESTIONNAIRE SURVEYAnn RC oll Surg Engl 2008; 90:5 61-564

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

“…One meta-analysis, by Leubke et al, 47 evaluated RFA alone and that by Jia et al 46 evaluated the efficacy and safety of FS alone. The meta-analyses published by Murad et al, 50 Luebke et al 48 and van den Bos et al 167 considered all three principal minimally invasive techniques, as well as LS, but found data only from 9, 12 and 8 relevant RCTs, respectively, with substantial duplication of included studies. Large numbers of observational studies, and some non-comparative studies 48,50,166 were also included in the analyses.…”

“…The relative efficacy of the interventions compared with stripping might be underestimated if surgeons are insufficiently experienced in performing the more recent minimally invasive techniques. 167 …”

“…167 In addition, most trial data currently relate to unilateral procedures, so there is a question as to the relative effectiveness and cost-effectiveness of simultaneous and sequential procedures for bilateral disease.…”

Comparing ultrasound guided foam sclerotherapy with surgical treatment in patients of varicose veins

“…The M:F ratio found in our study is in sharp contrast to the ratio mentioned in most of the western literature, where more females were suffering from this disease. 8,11,12,18,21,26 However in the study conducted by Jain et al, 41 of the 42 patients were males; by Masuda et al 42 of the 68 patients were males. 12,13 Majority of our patients were young with a mean age of 35.32 years in both group.…”

Outpatient Phlebosurgery — a Vector of the Effective Development of Medical Assistance for the Patients Presenting with Primary Varicosie veins?

“…В тот же период в Европе амбулаторная флебохирургия внедря -лась медленнее. В обзоре 2008 г., выполненном R. Winterborn и C. Corbett [11], показано, что хирурги Великобритании, во-первых, существенно уменьши-ли количество вмешательств при ВБНК по сравне-нию с 2001 г., а, во-вторых, предпочли традицион-ную флебэктомию у 83% пациентов в государствен-ных и у 72% -в частных клиниках. В обзорной статье H. Moore и соавт.…”