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Korany AO, Ismail AM, ElAskary NA, Kassem AM. The Effect of Superficial Venous Incompetence Treatment on Combined Segmental Deep Venous Reflux. Ann Vasc Surg 2024; 100:184-189. [PMID: 37865169 DOI: 10.1016/j.avsg.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The aim of this study was to assess the role of treatment of superficial venous reflux (SVR) in patients with combined deep segmental venous reflux as regards clinical symptoms as well as reflux improvement of the deep veins. METHODS We reviewed 80 patients, retrospectively selected on the inclusion criteria and having combined SVR and segmental deep venous reflux who underwent SVR ablation. The contralateral limb of 44 patients was used as a control group, asked to wear compression stockings for 3 months during day time with no surgical intervention. Duplex ultrasounds follow-up was performed at 3, 6, and 12 months postoperatively. Clinical severity of venous disease was graded from C1 to C6 according to the CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification. Duplex ultrasound was done in both supine and standing positions with non-weight-bearing of the examined limb. The venous reflux time, the venous flow volume and the peak venous flow velocity were registered. Removal of SVR was performed using either conventional surgery or radiofrequency ablation. The patient was required to wear compression stockings during the day time for the following weeks. RESULTS During the follow-up period, all patients were improved clinically as regards pain, edema, and ulcer healing. All patients included in this study had no signs of residual SVR. Corrected deep venous segment reflux was in 36 (45%). Similar data at 3, 6, and 12 months postoperatively after SVR removal. The popliteal vein reflux responded less than the femoral vein reflux did. CONCLUSIONS Treatment of the SVR eliminates segmental deep venous reflux in a good percentage of patients regardless of the treatment modality. Also, symptoms improvement and ulcer healing were documented, and hence, more studies are recommended to evaluate this role.
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Affiliation(s)
- Ahmed O Korany
- Faculty of Medicine, Vascular Surgery Unit, Alexandria University, Alexandria, Egypt.
| | - Ahmed M Ismail
- Faculty of Medicine, Vascular Surgery Unit, Tanta University, Alexandria, Egypt
| | | | - Ahmed M Kassem
- Faculty of Medicine, Vascular Surgery Unit, Alexandria University, Alexandria, Egypt
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Kikuchi R, Nhuch C, Drummond DAB, Santiago FR, Coelho F, Mauro FDO, Silveira FT, Peçanha GP, Merlo I, Corassa JM, Stambowsky L, Figueiredo M, Takayanagi M, Gomes Flumignan RL, Evangelista SSM, Campos W, Joviliano EE, de Araujo WJB, de Oliveira JCP. Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230064. [PMID: 38021274 PMCID: PMC10648055 DOI: 10.1590/1677-5449.202300642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/01/2023] [Indexed: 12/01/2023] Open
Abstract
The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.
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Affiliation(s)
- Rodrigo Kikuchi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas Santa Casa de São Paulo – FCMSCSP, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
| | - Claudio Nhuch
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Vascular, Porto Alegre, RS, Brasil.
| | - Daniel Autran Burlier Drummond
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-Rio, Departamento de Ciências da Computação, Rio de Janeiro, RJ, Brasil.
| | - Fabricio Rodrigues Santiago
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
- Instituto de Doenças Venosas e Linfáticas – IDVL, Goiânia, GO, Brasil.
| | - Felipe Coelho
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Paraná – PUCPR, Departamento de Cirurgia, Londrina, PR, Brasil.
| | | | | | | | - Ivanesio Merlo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Jose Marcelo Corassa
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Leonardo Stambowsky
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Marcondes Figueiredo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Miriam Takayanagi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Ronald Luiz Gomes Flumignan
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal de São Paulo – UNIFESP, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Solange Seguro Meyge Evangelista
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Varizemed, Belo Horizonte, MG, Brasil.
| | - Walter Campos
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, Disciplina de Cirurgia Vascular, São Paulo, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina – FMRP, Departamento de Cirurgia e Anatomia, São Paulo, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Paraná – UFPR, Residência em Angiorradiologia e Cirurgia Vascular, Hospital de Clínicas, Curitiba, PR, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia Geral e Especializada, Rio de Janeiro, RJ, Brasil.
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3
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Viljamaa J, Firoozi K, Venermo M, Pokela M, Pihlaja T, Halmesmäki K, Hakovirta H. A study protocol for comparing the treatment of varicose tributaries either concomitantly with or separately from endovenous laser ablation of the incompetent saphenous trunk (the FinnTrunk Study). A multicenter parallel-group randomized controlled study. PLoS One 2023; 18:e0285823. [PMID: 37220130 DOI: 10.1371/journal.pone.0285823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Opinions on the treatment of varicose tributaries in relation to saphenous ablation in varicose disease vary. Moreover, the possible role of the tributaries regarding the recurrence of varicose disease remains unclear. The aim of the FinnTrunk study is to compare two different treatment strategies for varicose disease in a randomized setting. In group one, the initial treatment will entail endovenous laser ablation (EVLA) of the incompetent saphenous trunk without tributary treatment. In group two, the varicose tributaries will be treated with ultrasound-guided foam sclerotherapy (UGFS) concomitantly with truncal ablation. The primary outcome measure is the need for additional procedures during the follow-up. The secondary outcome measures are the cost of treatment and recurrence of varicose disease. METHODS Consecutive patients with symptomatic varicose disease (CEAP clinical class C2-C3) will be screened for the study. Patients who fulfil the study criteria and give their informed consent will be scheduled for the procedure and randomized to either study group. Patients will be followed-up at 3 months, 1 year, 3 years, and 5 years. The post-procedure pain score based on a numeric rating scale (NRS) and also the use of analgesics, as well as possible procedure-related complications will be recorded at 3 months. Patient-reported outcome measures (PROMs) will be recorded at 1 year. Data pertaining to the additional treatment of varicose tributaries, the Aberdeen Varicose Vein Questionnaire (AVVQ), the Venous Clinical Severity Score (VCSS), and the health-related quality of life (EQ-5D-5L) will be collected at each follow-up visit. A duplex ultrasound (DUS) examination will be performed at each visit, and data on varicose tributaries and the need for additional treatment will be recorded. TRIAL REGISTRATION Registered on ClinicalTrials.gov, ID NCT04774939.
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Affiliation(s)
- Jaakko Viljamaa
- University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Khalil Firoozi
- University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Pokela
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
- University of Oulu, Oulu, Finland
| | - Toni Pihlaja
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
- University of Oulu, Oulu, Finland
| | - Karoliina Halmesmäki
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Hakovirta
- University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
- Satasairaala, Pori, Finland
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Pannier F, Noppeney T, Alm J, Breu FX, Bruning G, Flessenkämper I, Gerlach H, Hartmann K, Kahle B, Kluess H, Mendoza E, Mühlberger D, Mumme A, Nüllen H, Rass K, Reich-Schupke S, Stenger D, Stücker M, Schmedt CG, Schwarz T, Tesmann J, Teßarek J, Werth S, Valesky E. S2k guidelines: diagnosis and treatment of varicose veins. DER HAUTARZT; ZEITSCHRIFT FUR DERMATOLOGIE, VENEROLOGIE, UND VERWANDTE GEBIETE 2022; 73:1-44. [PMID: 35438355 PMCID: PMC9358954 DOI: 10.1007/s00105-022-04977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- F Pannier
- Praxis für Dermatologie und Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany.
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 224] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
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Laukkavirta M, Blomgren K, Halmesmäki K, Nikulainen V, Helmiö P. Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017. Phlebology 2020; 36:260-267. [PMID: 33045906 DOI: 10.1177/0268355520964294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI). METHODS PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified. RESULTS Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal. CONCLUSIONS PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common.
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Affiliation(s)
- Minna Laukkavirta
- Department of Vascular Surgery, Kanta-Häme Central Hospital, University of Turku, Hämeenlinna, Finland
| | - Karin Blomgren
- Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Veikko Nikulainen
- Department of Vascular Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Päivi Helmiö
- Department of Vascular Surgery, Turku University Hospital, University of Turku, Turku, Finland
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Tan MK, Sutanto SA, Onida S, Davies AH. The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 57:851-857. [DOI: 10.1016/j.ejvs.2019.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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Radhakrishnan N, George D, Jayakrishnan R, Sumi S, Kartha C. Vein Size and Disease Severity in Chronic Venous Diseases. Int J Angiol 2018; 27:185-189. [PMID: 30410288 PMCID: PMC6221802 DOI: 10.1055/s-0038-1639355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Given the high prevalence of chronic venous diseases (CVD), defining criteria to screen patients who are in need for intervention is attaining primacy. An important clinical criterion for treating CVD is incompetence of larger veins. We have assessed the association of size of afflicted veins with disease severity in patients with CVD to define an acceptable criterion to identify patients who need intervention. Demographic characteristics and risk factors were recorded from 6350 patients. Based on physical examination and venous duplex ultrasound study, patients were classified into clinical severity, etiology, anatomy, and pathophysiology (CEAP) classes and grouped according to the size of the veins which had varicosities. Patients with reflux in smaller veins (vein size <4 mm diameter) were considered as type I and those with varicosities in truncal veins (>4 mm diameter) as type II. Risk ratio was determined by multivariate regression analysis. About 47.67% of patients in this study were found to have CEAP class 3 disease. Compared with varicose veins of large truncal veins, patients with varicosities in smaller superficial veins had 2.85-fold ( p < 0.01) more risk of edema and 5.71-fold ( p < 0.01) higher prevalence of hyperpigmentation. Varicosities in small superficial veins were associated with higher risk of ulceration (odds ratio 3.93, 95% confidence interval 2.51-6.18) compared with truncal vein reflux. Our study reveals that presence of small varicose veins in patients without truncal saphenous reflux involvement is associated with severe manifestations of venous insufficiency such as edema and skin lesions even in the absence of varicosities in truncal saphenous veins.
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Affiliation(s)
- N. Radhakrishnan
- St.Thomas Institute of Research on Venous Diseases, Changanassery, Kerala, India
| | - Deepu George
- St.Thomas Institute of Research on Venous Diseases, Changanassery, Kerala, India
| | - R. Jayakrishnan
- St.Thomas Institute of Research on Venous Diseases, Changanassery, Kerala, India
- Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - S. Sumi
- Department of Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - C.C. Kartha
- Department of Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
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Carradice D, Forsyth J, Mohammed A, Leung C, Hitchman L, Harwood AE, Wallace T, Smith GE, Campbell B, Chetter I. Compliance with NICE guidelines when commissioning varicose vein procedures. BJS Open 2018; 2:419-425. [PMID: 30511042 PMCID: PMC6253791 DOI: 10.1002/bjs5.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168. Methods Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes. Results Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a 'trial' of conservative treatment; 22 (10·8 per cent) used lifestyle-related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated. Discussion The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle-related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - J Forsyth
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A Mohammed
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - C Leung
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - L Hitchman
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A E Harwood
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - T Wallace
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - G E Smith
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - B Campbell
- Department of Vascular Surgery Royal Devon and Exeter Hospital (Wonford) Exeter UK
| | - I Chetter
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
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10
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Lane TRA, Varatharajan L, Fiorentino F, Shepherd AC, Zimmo L, Gohel MS, Franklin IJ, Davies AH. Truncal varicose vein diameter and patient-reported outcome measures. Br J Surg 2017; 104:1648-1655. [DOI: 10.1002/bjs.10598] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 04/08/2017] [Accepted: 04/14/2017] [Indexed: 12/25/2022]
Abstract
Abstract
Background
Varicose veins and chronic venous disease are common, and some funding bodies ration treatment based on a minimum diameter of the incompetent truncal vein. This study assessed the effect of maximum vein diameter on clinical status and patient symptoms.
Methods
A prospective observational cohort study of patients presenting with symptomatic varicose veins to a tertiary referral public hospital vascular clinic between January 2011 and July 2012. Patients underwent standardized assessment with venous duplex ultrasonography, and completed questionnaires assessing quality of life (QoL) and symptoms (Aberdeen Varicose Vein Questionnaire, EuroQol Five Domain QoL assessment and EuroQol visual analogue scale). Clinical scores (Venous Clinical Severity Score (VCSS) and Clinical Etiologic Anatomic Pathophysiologic (CEAP) class) were also calculated. Regression analysis was used to investigate the relationship between QoL, symptoms and vein diameter.
Results
Some 330 patients were assessed before surgery. The median maximum vein diameter was 7·0 (i.q.r. 5·3–9·2) mm overall, 7·9 (6·0–9·8) mm for great saphenous vein and 6·0 (5·2–8·9) mm for small saphenous vein. In linear regression analysis, vein diameter was shown to have a significant association with VCSS (P = 0·041). For every 1-mm increase in vein diameter, there was a 2·75-fold increase in risk of being in CEAP class C4 compared with C2. No other QoL or symptom measures were related to vein diameter.
Conclusion
Incompetent truncal vein diameter was associated with increasing VCSS, but not a variety of other varicose vein disease-specific and generic patient-reported outcome measures.
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Affiliation(s)
- T R A Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - L Varatharajan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - F Fiorentino
- Imperial College Trials Unit and Department of Surgery, Imperial College London, St Mary's Hospital, London, UK
| | - A C Shepherd
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - L Zimmo
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
| | - M S Gohel
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
- Department of Vascular Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - I J Franklin
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
- London Vascular Clinic, London, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, UK
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11
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Paravastu SCV, Horne M, Dodd PDF. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev 2016; 11:CD010878. [PMID: 27898181 PMCID: PMC6464398 DOI: 10.1002/14651858.cd010878.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Short (or small) saphenous vein (SSV) varices occur as a result of an incompetent sapheno-popliteal junction, where the SSV joins the popliteal vein, resulting in reflux in the SSV; they account for about 15% of varicose veins. Untreated varicose veins may sometimes lead to ulceration of the leg, which is difficult to manage. Traditionally, treatment was restricted to surgery or conservative management. Since the 1990s, however, a number of minimally invasive techniques have been developed; these do not normally require a general anaesthetic, are day-case procedures with a quicker return to normal activities and avoid the risk of wound infection which may occur following surgery. Nerve injury remains a risk with thermal ablation, but in cases where it does occur, the injury tends to be transient. OBJECTIVES To compare the effectiveness of endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS) versus conventional surgery in the treatment of SSV varices. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Specialised Register (last searched 17 March 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2). We searched clinical trials databases for details of ongoing or unpublished studies. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) comparing EVLA, endovenous RFA or UGFS with conventional surgery in the treatment of SSV varices for inclusion. DATA COLLECTION AND ANALYSIS We independently reviewed, assessed and selected trials that met the inclusion criteria; any disagreements were resolved by discussion. We extracted data and used the Cochrane's tool for assessing risk of bias. When the data permitted, we performed either fixed-effect meta-analyses with odds ratios (ORs) and 95% confidence intervals (CIs) or random-effects meta-analyses where there was moderate to significant heterogeneity. MAIN RESULTS We identified three RCTs, all of which compared EVLA with surgery; one also compared UGFS with surgery. There were no trials comparing RFA with surgery. The EVLA versus surgery comparison included 311 participants: 185 received EVLA and 126 received surgery. In the UGFS comparison, each treatment group contained 21 people. For several outcomes in the EVLA comparison, only a single study provided relevant data; as a result, the current review is limited in its ability to demonstrate meaningful results for some planned outcomes. The quality of evidence according to GRADE was moderate to low for the outcome measures in the EVLA versus surgery comparison, but low for the UGFS versus surgery comparison. Reasons for downgrading in the EVLA versus surgery comparison were risk of bias (for some outcomes, the outcome assessors were not blinded; and in one study the EVLA-surgery allocation of 2:1 did not appear to be prespecified); imprecision (data were only available from a single small study and the CIs were relatively wide); indirectness (one trial reported results at six months rather than one year and was inadequately powered for SSV varices-only analysis). Reasons for downgrading in the UGFS versus surgery comparison were imprecision (only one trial offered UGFS and several participants were missing from the analysis) and a limitation in design (the study was inadequately powered for SSV participants alone).For the EVLA versus surgery comparison, recanalisation or persistence of reflux at six weeks occurred less frequently in the EVLA group than in the surgery group (OR 0.07, 95% CI 0.02 to 0.22; I2 = 51%; 289 participants, 3 studies, moderate-quality evidence). Recurrence of reflux at one year was also less frequent in the EVLA group than in the surgery group (OR 0.24, 95% CI 0.07 to 0.77; I2 = 0%; 119 participants, 2 studies, low-quality evidence). For the outcome clinical evidence of recurrence (i.e. presence of new visible varicose veins) at one year, there was no difference between the two treatment groups (OR 0.54, 95% CI 0.17 to 1.75; 99 participants, 1 study, low-quality evidence). Four participants each in the EVLA and surgery groups required reintervention due to technical failure (99 participants, 1 study, moderate-quality evidence). There was no difference between the two treatment groups for disease-specific quality of life (QoL) (Aberdeen Varicose Veins Questionnaire) either at six weeks (mean difference (MD) 0.15, 95% CI -1.65 to 1.95; I2 = 0%; 265 participants, 2 studies, moderate-quality evidence), or at one year (MD -1.08, 95% CI -3.39 to 1.23; 99 participants, 1 study, low-quality evidence). Main complications reported at six weeks were sural nerve injury, wound infection and deep venous thrombosis (DVT) (one DVT case in each treatment group; EVLA: 1/161, 0.6%; surgery 1/104, 1%; 265 participants, 2 studies, moderate-quality evidence).For the UGFS versus surgery comparison, there were insufficient data to detect clear differences between the two treatment groups for the two outcomes recanalisation or persistence of reflux at six weeks (OR 0.34, 95% CI 0.06 to 2.10; 33 participants, 1 study, low-quality evidence), and recurrence of reflux at one year (OR 1.19, 95% CI 0.29 to 4.92; 31 participants, 1 study, low-quality evidence). No other outcomes could be reported for this comparison because the study data were not stratified according to saphenous vein. AUTHORS' CONCLUSIONS Moderate- to low-quality evidence exists to suggest that recanalisation or persistence of reflux at six weeks and recurrence of reflux at one year are less frequent when EVLA is performed, compared with conventional surgery. For the UGFS versus conventional surgery comparison, the quality of evidence is assessed to be low; consequently, the effectiveness of UGFS compared with conventional surgery in the treatment of SSV varices is uncertain. Further RCTs for all comparisons are required with longer follow-up (at least five years). In addition, measurement of outcomes such as recurrence of reflux, time taken to return to work, duration of procedure, pain, etc., and choice of time points during follow-up should be standardised such that future trials evaluating newer technologies can be compared efficiently.
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Affiliation(s)
| | - Margaret Horne
- The University of Edinburgh Medical SchoolCentre for Population Health SciencesTeviot PlaceEdinburghUK
| | - P Dominic F Dodd
- Northern General HospitalSheffield Vascular InstituteHerries RoadSheffieldUKS5 7AU
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Onida S, Shalhoub J, Moore HM, Head KS, Lane TRA, Davies AH. Factors impacting on patient perception of procedural success and satisfaction following treatment for varicose veins. Br J Surg 2016; 103:382-90. [DOI: 10.1002/bjs.10117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/27/2015] [Accepted: 12/22/2015] [Indexed: 01/25/2023]
Abstract
Abstract
Background
Patient-reported outcome measures (PROMs) have been collected from patients undergoing varicose vein treatments in the National Health Service since 2009. The aim of this retrospective cohort study was to examine PROMs for varicose vein interventions, characterizing factors that might predict patient-reported perception of procedural success and satisfaction.
Methods
Centrally compiled PROMs data for varicose vein procedures carried out from 2009 to 2011 were obtained from the Hospital Episode Statistics data warehouse for England. As data were not distributed normally, non-parametric statistical tests were employed.
Results
Data for 35 039 patient episodes (62·8 per cent women) were available for analysis. Some 23·4 per cent of patients reported a degree of anxiety or depression before treatment; a formal diagnosis of depression was present in 7·8 per cent. Quality of life, measured by generic EQ-5D-3L™ index and the Aberdeen Varicose Vein Questionnaire (AVVQ) improved after intervention by 11·7 per cent (0·77 to 0·86) and 40·1 per cent (18·95 to 11·36) respectively. No significant improvement was found in EQ-5D™ visual analogue scale scores. There was a significant improvement in self-perceived anxiety or depression after the intervention (P < 0·001, McNemar–Bowker test). Both preoperative and postoperative depression or anxiety had a statistically significant relationship with self-reported success and satisfaction (both P < 0·001, χ2 test).
Conclusion
This analysis of PROMs is evidence that treatment of varicose veins improves quality of life, and anxiety or depression. Preoperative and postoperative anxiety or depression scores impact on patient-perceived success and satisfaction rates.
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Affiliation(s)
- S Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4th Floor, East Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - J Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4th Floor, East Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - H M Moore
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4th Floor, East Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - K S Head
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4th Floor, East Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - T R A Lane
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4th Floor, East Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4th Floor, East Wing, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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