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Sun CR, Liu MY, Ni QH, Cai F, Tang F, Yu ZY, Zhang JB, Zhang L, Zhang WW, Li CM. Clinical Guidelines on Compression Therapy in Venous Diseases. Ann Vasc Surg 2024:S0890-5096(24)00451-5. [PMID: 39032593 DOI: 10.1016/j.avsg.2024.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND In recent years, compression therapy has attracted gradually increasing clinical attention in lower extremity venous diseases. However, basic concepts and clear nomenclature, standard treatment methods, and consistent product standards for pressure equipment are lacking. Therefore, developing clinical guidelines for compression therapy is essential to improving the treatment of venous diseases. METHODS Our panel generated strong (grade I), moderate (grade IIa and IIb), and weak (grade III) recommendations based on high-quality (class A), moderate-quality (class B), and low-quality (class C) evidence, using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach and the European Society of Cardiology (ESC) grading system. RESULTS The panels made 30 recommendations from current evidence, focusing on 7 fields of lower extremity venous disease (venous thromboembolism, post-thrombotic syndrome (PTS), chronic venous insufficiency (CVI), varicose veins, hemangioma and vascular malformations, lymphedema, and venous ulcers) and 18 topics. CONCLUSIONS Of the 30 recommendations made across the 18 topics, 7 were strong (grade I) and 17 were based on high-quality (class A) evidence, highlighting the need for further research of the use of compression therapy.
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Affiliation(s)
- Cong-Rui Sun
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming-Yuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qi-Hong Ni
- Department of Vascular Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Fei Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Tang
- Department of Vascular Surgery, The First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Zi-You Yu
- The Department of Plastic and Reconstructive Surgery, The Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Bin Zhang
- The Department of Cardiovascular Surgery, China-Friendship Hospital, Beijing, China
| | - Long Zhang
- Department of Vascular Surgery, Peking University Third Hospital, Beijing, China
| | | | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Dietrich CK, Stucker M, Hartmann K, Hirsch T, Mattausch T, Wenzel HC, Zollmann P, Veltman J, Weiler TK, Lengfellner G, Müller L, Pannier F, Cussigh C, Uhlmann L, Müller-Christmann C. Compression therapy after endovenous laser ablation: Patient compliance and impact on clinical outcome. Phlebology 2024:2683555241249222. [PMID: 38712381 DOI: 10.1177/02683555241249222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVES This study aimed to investigate the impact of post-interventional compression therapy on clinical outcomes after endovenous laser ablation (EVLA) of incompetent saphenous veins. METHODS This prospective, controlled, multicenter study in Germany involved 493 varicose vein patients followed-up for 6 months. RESULTS Compression therapy significantly reduced symptoms compared to no compression (VCSS: 1.4 ± 1.6 vs 2.2 ± 2.2; p = .007). Post-interventional therapy duration of up to 14 days was found to be most effective for improving patient-reported disease severity (p < .001) and higher quality of life (p = .001). Patient compliance was high (82%), and non-compliance was linked to worse disease severity (VCSS 1.4 ± 1.5 vs 2.1 ± 2.3, p = .009). CONCLUSION In conclusion, post-interventional compression therapy is beneficial by reducing symptoms and improving quality of life. High patient compliance with the therapy is observed, and non-compliance is associated with worse disease severity.
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Affiliation(s)
- Carmen K Dietrich
- Department for Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Markus Stucker
- Venenzentrum der Dermatologischen und Gefaßchirurgischen Kliniken, Bochum, Germany
| | | | - Tobias Hirsch
- Praxis fur Innere Medizin und Gefaßkrankheiten, Halle/Saale, Halle, Germany
| | | | | | | | | | | | | | | | | | - Christiane Cussigh
- Department for Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
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Su L, Zhang L, Yuan T, Ji L, Liu M, Li R, Lv H, Guo S. Compression Therapy after Thermal Ablation of Varicose Veins: A Meta-Analysis. Skin Res Technol 2024; 30:e13652. [PMID: 38572582 PMCID: PMC10993052 DOI: 10.1111/srt.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To investigate whether compression therapy after thermal ablation of varicose veins can improve the prognosis of patients. METHODS Systematic research were applied for Chinese and English electronic databases(PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP Databases). Eligible prospective studies that comparing the efficacy of compression therapy and non-compression therapy on patients after thermal ablation of varicose veins were included. The interest outcome such as pain, quality of life (QOL), venous clinical severity score (VCSS), time to return to work and complications were analyzed. RESULTS 10 studies were of high quality, and randomized controlled trials involving 1,545 patients met the inclusion criteria for this study. At the same time, the meta-analysis showed that the application of compression therapy improved pain (SMD: -0.51, 95% CI: -0.95, -0.07) but exhibited no statistically significant effect on QOL (SMD: 0.04, 95% CI: -0.08, 0.16), VCSS (MD: -0.05, 95% CI: -1.19, 1.09), time to return to work (MD: -0.43, 95% CI: -0.90, 0.03), total complications (RR: 0.54, 95% CI: 0.27, 1.09), and thrombosis (RR: 0.71, 95% CI: 0.31, 1.62). CONCLUSION Compression therapy after thermal ablation of varicose veins can slightly relieve pain, but it has not been found to be associated with improvement in other outcomes.
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Affiliation(s)
- Li Su
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Ling Zhang
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Tao Yuan
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Li‐Ping Ji
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Meng Liu
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Rong‐Zhen Li
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Hai‐Ling Lv
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Shu‐Yun Guo
- Department of Vascular SurgeryThe Second Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
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Mirakhmedova S, Amirkhanov A, Seliverstov E, Efremova O, Zolotukhin I. Daily Duration of Compression Treatment in Chronic Venous Disease Patients: A Systematic Review. J Pers Med 2023; 13:1316. [PMID: 37763085 PMCID: PMC10533179 DOI: 10.3390/jpm13091316] [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: 08/04/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Background: There are no data on the daily regimen of compression therapy in patients with chronic venous disease. This systematic review aimed to establish the optimal daily duration of compression treatment. Methods: A systematic search of CENTRAL and MEDLINE was performed to identify RCTs, non-RCTs, reviews, systematic reviews, meta-analyses, and guidelines evaluating the use of compression regimens in the treatment of varicose veins. Results: Thirty-two RCTs, three non-RCTs, four observational studies, and two crossover trials reporting the duration and regimes of compression treatment fulfilled the inclusion criteria. The daily duration of compression was reported in patients after invasive treatment, for venous ulcer treatment, in patients with venous symptoms. The quality of the studies varied. We could not conduct a meta-analysis due to the heterogeneity of the research data and their quality. Twenty-three studies reported results of compression usage after invasive procedures. Eight studies reported daily duration regimens in patients with venous ulcers. Nine studies reported the impact of compression on venous symptoms and/or edema or limb volume change. One study was conducted to assess if compression improves QoL in venous patients. While there was a clear difference found in the daily duration depending on the clinical scenario, no data in support of exact regimens were found. Conclusions: There are no reliable data supporting exact daily regimens of compression treatment in various cohorts of CVD patients.
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Affiliation(s)
| | | | | | | | - Igor Zolotukhin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow 117997, Russia; (S.M.); (A.A.); (E.S.); (O.E.)
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Coelho F, Araújo WJB, Belczak S, Rui EF, Borsato BB, Baldesserra NF, de Oliveira RG. Influence of compression therapy following varicose vein surgery: a prospective randomized study. J Vasc Bras 2023; 22:e20220052. [PMID: 37576735 PMCID: PMC10421576 DOI: 10.1590/1677-5449.202200522] [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: 04/24/2022] [Accepted: 04/04/2023] [Indexed: 08/15/2023] Open
Abstract
Background The use of compression dressings after phlebectomy is based solely on clinical experience due to the lack of a unified set of definitive recommendations, which makes clinical practice extremely heterogeneous. Objectives To evaluate compression therapy with elastic stockings for 7 days after phlebectomy. Methods We randomly allocated 104 lower limbs with disease classified as C1 and C2 to 1 of 2 groups: an intervention group (64 limbs) - wearing elastic compression stockings for the first 7 days after phlebectomy; or a control group (40 limbs) - given conventional bandaging for 24 hours postoperatively. We compared clinical response by analyzing the evolution of symptoms, hematoma formation, and preoperative vs. postoperative limb volume. Results Pain (median 1.0 vs. 1.5, p=0.0320) and limb volume (mean 43.7 vs. 99.8, p=0.0071) were significantly improved in patients wearing elastic compression stockings for 7 days after phlebectomy compared with controls. Conclusions Use of elastic compression therapy for 7 days after phlebectomy was effective for improving pain and lower limb volume.
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Affiliation(s)
- Felipe Coelho
- Pontifícia Universidade Católica do Paraná – PUCPR, Londrina, PR, Brasil.
| | | | - Sergio Belczak
- Centro Universitário São Camilo – CUSC, São Paulo, SP, Brasil.
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Zhang D, Shi C, Zhang Y, Cui Q, Zhai S, Huang Y, Zhou C, Chen Q. Compression versus no compression after endovenous radiofrequency ablation: A meta-analysis of randomized controlled trials. Phlebology 2022; 37:555-563. [PMID: 35713027 DOI: 10.1177/02683555221108568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this meta-analysis was to compare compression with no-compression, after radiofrequency endothermal ablation of a truncal varicose vein. METHODS Databases, such as PubMed, Embase, Cochran Library, and Web of Science, were independently searched by two researchers for relevant literature, preliminary screening was performed, and the full text was read to select studies that met the inclusion criteria. The quality of the included literature was evaluated using the Cochrane Risk of Bias tool, and meta-analysis was performed using Review Manager 5.4. RESULTS A total of four randomized controlled trials were included and a total of 552 patients were involved. Among them, 273 patients were in the compression group and 279 in the no-compression group. Meta-analysis results showed that the pain using the 100 mm Visual Analogue Scale was lower in the compression group than the pain in the no-compression group (MD = -4.22, 95% CI = -7.95 - -0.49, p = 0.03). No significant differences in terms of occlusion rate (RR = 0.99, 95% CI = 0.96-1.02, p = 0.55), Aberdeen Varicose Vein Questionnaire (MD = 0.46, 95% CI = -0.80-1.73, p = 0.47), and complications (OR = 1.33, 95% CI = 0.61-2.94, p = 0.47) were observed between groups. CONCLUSIONS This meta-analysis suggests that compression therapy reduced post-operative pain compared to the no-compression group. However, no additional advantages were observed in terms of occlusion rates, quality of life scores and complications.
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Affiliation(s)
- Dengxiao Zhang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, China.,Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
| | - Chaohai Shi
- Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
| | - Yuan Zhang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, China.,Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
| | - Qi Cui
- Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
| | - Shaobo Zhai
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, China.,Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
| | - Yalong Huang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, China.,Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
| | - Cong Zhou
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, China.,Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
| | - Quan Chen
- Department of Vascular Surgery, 91589Gansu Provincial Hospital, Lanzhou, China
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Pihlaja T, Mella M, Ohtonen P, Romsi P, Pokela M. Recovery and patient satisfaction following radiofrequency ablation and concomitant foam sclerotherapy of varicose veins with and without compression: A randomized controlled non-inferiority trial. Phlebology 2022; 37:303-311. [DOI: 10.1177/02683555221077742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The benefits of postoperative compression are not well established following radiofrequency ablation of the truncal vein and concomitant foam sclerotherapy. Methods A total of 104 patients were randomized: Postoperatively, 54 patients received no compression and 50 patients received class II thigh-high compression. The primary outcome for this study was the difference between means on postoperative pain scores over the first 10 days follow-up measured on a visual analog scale (VAS) from 0 to 100 mm (prespecified delta 10 mm). Results The difference between means in no compression and compression group on postoperative pain scores over the 10 days follow-up was 2.1 mm (95% confidence interval −5.1–9.3 mm; p = 0.28) indicating non-inferiority. Patients in the no compression group were more satisfied with the visual appearance of the treated leg at 1 month ( p = 0.003). Conclusion Over the first 10 postoperative days, no compression was non-inferior to compression on pain scores.
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Affiliation(s)
- Toni Pihlaja
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Minna Mella
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Pekka Romsi
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
| | - Matti Pokela
- Department of Vascular Surgery, Oulu University Hospital, Oulu, Finland
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8
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OUP accepted manuscript. Br J Surg 2022; 109:679-685. [DOI: 10.1093/bjs/znac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022]
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Ma F, Xu H, Zhang J, Premaratne S, Gao H, Guo X, Yang T. Compression Therapy Following Endovenous Thermal Ablation of Varicose Veins: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 80:302-312. [PMID: 34774690 DOI: 10.1016/j.avsg.2021.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis were performed to evaluate the necessity for compression therapy with elastic stockings following endovenous thermal ablation (EVTA) for chronic venous insufficiency. METHODS MedLine, ScienceDirect and the Cochrane Library were searched for the relevant literature according to the inclusion and exclusion criteria. Two researchers independently extracted data and assessed the quality of the literature. Randomized controlled trials comparing the use of elastic stockings for compression therapy versus no compression therapy following RFA or EVLA for varicose veins were included in this study. The primary outcome of postoperative pain was assessed using the visual analogue pain scale. Secondary outcomes included the bruising score, quality of life, venous clinical severity score, time to return to normal activities, complications, and the rate of saphenous vein occlusion. The mixed effect model or random effect model was used to calculate relative risk (RR), mean difference (MD) or standardized mean difference following the heterogeneity test. Sensitivity analysis was performed for outcomes with high heterogeneity (I2 >50%). Outcomes were described qualitatively for studies that could not be pooled. RESULTS Six RCTs with 1,045 subjects were included. Overall, postoperative compression therapy significantly reduced the mean pain in the first 10 days post-EVTA (MD = - 4.98,95% CI: -8.71 to -1.24), and the time to return to normal activities (MD = -1.01, 95% CI: -1.97 to -0.06). In terms of the bruising score, the venous clinical severity score, complications (RR = 1.05,95% CI: 0.55-2.00), quality of life at 2 weeks (MD = -0.71,95% CI: -2.09 to 0.67) and 6 months (MD = 0.26,95% CI: -1.22 to 1.74), and the saphenous vein occlusion rate (RR=1.00,95% CI: 0.95-1.04), there were no significant differences between the compression and control groups. CONCLUSION Our study recommends the routine use of compression therapy with elastic stockings following EVTA of varicose veins to reduce postoperative pain and the time to return to normal activities. However, further multi-center and high-quality randomized clinical trials are needed for the unified treatment for varicose veins, the target population as well as the duration of compression therapy on whether elastic stockings is beneficial following EVTA.
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Affiliation(s)
- Fan Ma
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Huimin Xu
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Jiantao Zhang
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Shyamal Premaratne
- Hunter Holmes McGuire Veterans Administration Medical Center, Richmond, VA
| | - Hongxia Gao
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Xiaorong Guo
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China
| | - Tao Yang
- Department of Vascular Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences and Tongji Shanxi Hospital, Tongji Medical College of HUST, Taiyuan, China.
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Hu H, Wang J, Wu Z, Liu Y, Ma Y, Zhao J. No Benefit of Wearing Compression Stockings after Endovenous Thermal Ablation of Varicose Veins: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 63:103-111. [PMID: 34776296 DOI: 10.1016/j.ejvs.2021.09.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/03/2021] [Accepted: 09/18/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This meta-analysis was conducted to investigate whether compression stockings were necessary after endovenous thermal ablation of varicose veins. DATA SOURCES Electronic databases, including MEDLINE, EMBASE, and the Cochrane Library database, were searched from inception to 10 March 2021 to identify all the related trials. METHODS Random or fixed effects models were used to generate pooled mean difference (MD) or standardised mean difference (SMD) for continuous data, risk ratios (RRs) for dichotomous data, and related 95% confidence intervals (95% CIs). The quality of evidence was graded with a specific tool (GRADEpro GDT) from the GRADE working group. RESULTS A total of seven randomised controlled trials (RCTs) comprising 1 146 patients were included in this meta-analysis. Wearing compression stockings was correlated with lower post-operative pain scores from a 0 to 100 mm visual analogue scale (MD -8.00; 95% CI -12.01 - -3.99; p < .001). No difference was observed between wearing compression stockings or not in quality of life (SMD 0.45; 95% CI 0.14 - 1.04), major complications (RR 0.64; 95% CI 0.26 -1.59), target vein occlusion rates (RR 0.99; 95% CI 0.96 - 1.02), or time to return to work (MD -0.43; 95% CI 1.06 - 0.19). CONCLUSION After endovenous thermal ablation of varicose veins, wearing compression stockings was not associated with a better outcome except for mild pain relief. Post-operative compression stockings may be unnecessary after endovenous thermal ablation.
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Affiliation(s)
- Huanrui Hu
- Department of Vascular Surgery and National Clinical Research Centre for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department of Vascular Surgery and National Clinical Research Centre for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Zhoupeng Wu
- Department of Vascular Surgery and National Clinical Research Centre for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yang Liu
- Department of Vascular Surgery and National Clinical Research Centre for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yukui Ma
- Department of Vascular Surgery and National Clinical Research Centre for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery and National Clinical Research Centre for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
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Mii S, Guntani A, Yoshiga R, Matsumoto T, Kawakubo E, Okadome J. Optimal Duration of Compression Stocking Therapy after Endovenous Laser Ablation Using a 1470-nm Diode Dual-Ring Radial Laser Fiber for Great Saphenous Vein Insufficiency. Ann Vasc Dis 2021; 14:122-131. [PMID: 34239637 PMCID: PMC8241551 DOI: 10.3400/avd.oa.21-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the optimal duration of compression therapy after endovenous laser ablation (EVLA) using a 1470-nm diode dual-ring radial laser fiber for great saphenous vein (GSV) insufficiency. Methods: Patients undergoing EVLA of GSV for varicose vein disease were divided into two groups based on the duration of subsequent compression after the procedure: short duration group (S group; 0–2 days) and long duration group (L group; 1–4 weeks). Patient-reported outcomes (pain and quality of life [QOL]) were set as the primary outcomes, and objective findings (venous clinical severity score [VCSS], leg circumference, and duplex ultrasound [DUS] findings) were set as the secondary outcomes. A follow-up examination was performed at 1 week and 1 and 6 months. Each variable between the groups was compared after a propensity score matching using the age, sex, Clinical–Etiological–Anatomical–Pathophysiological (CEAP) clinical class, job type, and target variable as covariates. A per-protocol analysis was performed. Results: The S and L groups included 98 and 99 patients, respectively. A propensity score matching analysis showed no significant differences between the groups in any outcomes at any follow-up intervals. Conclusion: Long-term compression showed little benefit; therefore, the prescription of compression stocking beyond 2 days after EVLA is unnecessary.
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Affiliation(s)
- Shinsuke Mii
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Fukuoka, Japan
| | - Atsushi Guntani
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Fukuoka, Japan
| | - Ryosuke Yoshiga
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Fukuoka, Japan
| | - Takuya Matsumoto
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Fukuoka, Japan
| | - Eisuke Kawakubo
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Fukuoka, Japan
| | - Jun Okadome
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Fukuoka, Japan
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Zolotukhin I, Demekhova M, Ilyukhin E, Sonkin I, Zakharova E, Efremova O, Kiseleva E, Gavrilov E. A randomized trial of class II compression sleeves for full legs versus stockings after thermal ablation with phlebectomy. J Vasc Surg Venous Lymphat Disord 2021; 9:1235-1240. [PMID: 33340729 DOI: 10.1016/j.jvsv.2020.12.067] [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: 09/10/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compression stockings and bandages are widely used after invasive treatment of varicose veins. The goals of compression after venous interventions are to reduce pain, bruising, and ecchymosis. Nevertheless, patients often report discomfort with the compression. To make postprocedural compression more tolerable, foot-sparing bandages were tested in a randomized clinical trial of noninferiority. METHODS A total of 187 patients were randomized to use class II foot-sparing compression sleeves for the full leg or class II stockings after radiofrequency ablation with concomitant phlebectomy. The primary endpoint was the quality of life, measured using the Chronic Venous Disease Quality of Life Questionnaire 20-item scale 30 days after intervention. The secondary endpoints were pain in the leg and discomfort related to the compression garment, which were assessed using the visual analog scale (VAS) at 2, 7, 14, and 30 days. RESULTS The global index score of the questionnaire was 66.1 and 70.6 and 83.8 and 87.7 for the sleeve and stocking groups before and 30 days after intervention, respectively (P = .542 and P = .150, respectively). The VAS for pain score in the operated leg was slightly higher in the sleeve group the day after the intervention (score, 2.1 vs 1.6; P = .03). At 7, 14, and 30 days, the VAS for pain scores did not differ significantly (score, 0.7 vs 0.5; 0.5 vs 0.3; and 0.1 vs 0.1, respectively; P = NS for all). The VAS for discomfort score was not significantly different statistically in the study group at 2 days (sleeve, 1.9; vs stocking, 1.4; P = .08) but was higher after 7 days (sleeve, 0.9; vs stocking, 0.6; P = .008). No difference in discomfort was found between the study and control groups at 14 or 30 days (sleeve, 0.6; vs stocking, 0.4; and sleeve, 0.4; vs stocking, 0.4, respectively; P = NS for both). CONCLUSIONS Quality of life after thermal ablation with phlebectomy improved equivalently in patients who had used class II compression sleeves for full legs and those who had used class II compression stockings. Pain and discomfort were slightly higher in the sleeve group.
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Affiliation(s)
- Igor Zolotukhin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russia.
| | - Marina Demekhova
- Department of Phlebology and Lymphology, Private Clinic "Medalp", St Petersburg, Russia
| | - Evgeny Ilyukhin
- Department of Phlebology and Lymphology, Private Clinic "Medalp", St Petersburg, Russia
| | - Igor Sonkin
- Department of Cardiovascular Surgery, Road Clinical Hospital of Russian Railways, St Petersburg, Russia
| | - Elena Zakharova
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Oksana Efremova
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ekaterina Kiseleva
- Department of Cardiovascular Surgery, Road Clinical Hospital of Russian Railways, St Petersburg, Russia
| | - Evgeny Gavrilov
- Department of Surgery, Military Medical Academy S. M. Kirov, St Petersburg, Russia
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Randomized Controlled Trial of Compression After Endovenous Thermal Ablation of Varicose Veins (COMETA Trial). Ann Surg 2021; 273:232-239. [PMID: 31850976 DOI: 10.1097/sla.0000000000003626] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 21st century has witnessed a rise in the use of endovenous thermal ablation. Being highly clinically and cost-effective and improving the quality of life of patients, they are now considered to be the "gold-standard" treatment for varicose veins. Post-intervention management, especially in terms of postoperative compression, however, remains unclear. As a result, a randomized study was undertaken to investigate the effects of wearing compression stockings after varicose vein treatment. METHOD Patients with saphenous vein reflux undergoing treatment with endothermal ablation (with or without concurrent phlebectomies) were randomized to receive either 7 days of compression stockings or no stockings. The primary outcome measure for this study was the pain score over the first 10 postoperative days. The pain scores, clinical score, time to return to normal activities, and ecchymosis were assessed. Patients were followed-up at 2 weeks and 6 months post-ablation. RESULTS In total, 206 patients were randomized, 49% of them to the compression group. The mean age was 49.7 (±16) years and approximately 51% of the population was male. The median pain score in the compression group using a visual analog scale was significantly lower on days 2-5, compared to the no compression group. Those having concurrent phlebectomies and compression stockings also had significantly better pain scores on days 1-3, day 5, and day 7. Improvement in the median venous clinical severity score was noted at 6-month follow-up, but this was not significant. No difference in the generic- or disease-specific quality of life was observed and the time to return to activities was similar. There were no differences in the degree of ecchymosis between the 2 groups and both groups had similar occlusion rates. CONCLUSIONS These results indicate that wearing compression stockings after endothermal ablation is advantageous in the first few days after treatment and is especially beneficial for those having concurrent phlebectomies.
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Gracia S, Miserey G, Risse J, Abbadie F, Auvert JF, Chauzat B, Combes P, Creton D, Creton O, Da Mata L, Diard A, Giordana P, Josnin M, Keïta-Perse O, Lasheras A, Ouvry P, Pichot O, Skopinski S, Mahé G. Update of the SFMV (French society of vascular medicine) guidelines on the conditions and safety measures necessary for thermal ablation of the saphenous veins and proposals for unresolved issues. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:130-146. [PMID: 32402427 DOI: 10.1016/j.jdmv.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Venous insufficiency is a very common disease affecting about 25% of the French population (if we combine all stages of its progression). It is a complex disease and its aetiology has not yet been fully elucidated. Some of its causes are well known, such as valvular dysfunction, vein wall defect, and the suctioning effect common to all varicose veins. These factors are generally associated and together lead to dysfunction of one or more of the saphenous veins. Saphenous vein dysfunction is revealed by ultrasound scan, a reflux lasting more than 0.5 seconds indicating venous incompetence. The potential consequences of saphenous vein dysfunction over time include: symptoms (heaviness, swellings, restlessness, cramps, itching of the lower limbs), acute complications (superficial venous thrombosis, varicose bleeding), chronic complications (changes in skin texture and colour, stasis dermatitis, eczema, vein atresia, leg ulcer), and appearance of unaesthetic varicose veins. It is not possible to repair an incompetent saphenous vein. The only therapeutic options at present are ultrasound-guided foam sclerotherapy, physical removal of the vein (saphenous stripping), or its thermal ablation (by laser or radiofrequency treatment), the latter strategy having now become the gold standard as recommended by international guidelines. Recommendations concerning thermal ablation of saphenous veins were published in 2014 by the Société française de médecine vasculaire. Our society has now decided to update these recommendations, taking this opportunity to discuss unresolved issues and issues not addressed in the original guidelines. Thermal ablation of an incompetent saphenous vein consists in destroying this by means of a heating element introduced via ultrasound-guided venous puncture. The heating element comprises either a laser fibre or a radiofrequency catheter. The practitioner must provide the patient with full information about the procedure and obtain his/her consent prior to its implementation. The checklist concerning the interventional procedure issued by the HAS should be validated for each patient (see the appended document).
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Affiliation(s)
- S Gracia
- Clinique de l'Atlantique, 17138 Puilboreau-La Rochelle, France.
| | - G Miserey
- Cabinet de Médecine Vasculaire, 78120 Rambouillet, France
| | - J Risse
- Hôpital Robert-Pax, 57200 Sarreguemines, France
| | - F Abbadie
- Hopital de Vichy, 03200 Vichy, France
| | - J F Auvert
- Cabinet de Médecine Vasculaire, 28100 Dreux, France
| | - B Chauzat
- Cabinet de Médecine Vasculaire, 24100 Bergerac, France
| | - P Combes
- Cabinet de Médecine Vasculaire, 64200 Biarritz, France
| | - D Creton
- Clinique Ambroise Paré, 54100 Nancy, France
| | - O Creton
- Hôpital Privé des Côtes d'Armor, 22190 Plérin, France
| | - L Da Mata
- Service d'Anesthésie et Réanimation Chirurgicale, Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France
| | - A Diard
- Clinique Sainte Anne, 33210 Langon, France
| | - P Giordana
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Nice, 06000 Nice, France
| | - M Josnin
- Clinique Saint-Charles, 85000 La Roche sur Yon, France
| | - O Keïta-Perse
- Centre Hospitalier Princesse Grace, Service Epidémiologie et Hygiène Hospitalière, 98000 Monaco, Monaco
| | - A Lasheras
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - P Ouvry
- Cabinet de Médecine Vasculaire, 76550 Saint-Aubin-sur-Scie, France
| | - O Pichot
- Centre de Médecine Vasculaire, 38000 Grenoble, France
| | - S Skopinski
- Service de Médecine Vasculaire Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - G Mahé
- Unité de Médecine Vasculaire, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France
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Onwudike M, Abbas K, Thompson P, McElvenny DM. Editor's Choice - Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial ☆. Eur J Vasc Endovasc Surg 2020; 60:108-117. [PMID: 32278637 DOI: 10.1016/j.ejvs.2020.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 02/12/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
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 C2-C6 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 = 47) and 98% (n = 45), respectively (p = 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference -1, 95% CI -2 - 3, p = .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI -1 - 2, p = .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p = .72) and pain score 2.0 vs. 2.0 (p = .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p = 1.0 for above the knee and p = 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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Affiliation(s)
- Madu Onwudike
- Vascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Vascular Surgery, Bolton Hospitals NHS Foundation Trust, Bolton, UK.
| | - Kazim Abbas
- Vascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paula Thompson
- Vascular Surgery, Bolton Hospitals NHS Foundation Trust, Bolton, UK
| | - Damien M McElvenny
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK
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Pihlaja T, Romsi P, Ohtonen P, Jounila J, Pokela M. Post-procedural Compression vs. No Compression After Radiofrequency Ablation and Concomitant Foam Sclerotherapy of Varicose Veins: A Randomised Controlled Non-inferiority Trial. Eur J Vasc Endovasc Surg 2019; 59:73-80. [PMID: 31753745 DOI: 10.1016/j.ejvs.2019.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare post-operative compression with no compression, after radiofrequency endothermal ablation (RFA) of a truncal varicose vein and concomitant foam sclerotherapy of the tributaries. METHODS This prospective randomised controlled, non-inferiority trial recruited patients from two centres in Northern Ostrobothnia, Finland. Patients with clinical class C2-C4 chronic venous disease were randomised to receive no compression after the operation, or to receive compression stockings continuously for two days, and then, during the daytime for five days. In follow up visits, additional foam sclerotherapy was performed for symptoms of distal incompetence. Patients were followed up for six months. The primary outcome was occlusion of the RFA treated truncal vein at six months. Secondary outcomes were return to full activity within 14 days, Aberdeen Varicose Vein Questionnaire (AVVQ) score, post-operative pain, need for painkillers, and postprocedural complications. RESULTS Of 177 included patients, 90 were allocated to post-operative compression and 87 to no compression. At six months, both groups showed 100% occlusion rates in RFA treated truncal veins (95% confidence interval -0.043-0.042). Within 14 days of treatment, full physical activity was achieved by 87% of the compression group and 81% of the no compression group, (p = .29). At six months, the AVVQ scores were comparable and significantly improved in both groups, compared with baseline. Pain scores were comparable between groups, in day to day analyses, and they were significantly lower in both groups on day 10, compared with pre-operative pain caused by varicose veins. On average, post-operative pain medication was used for 2.3 days and for 2.8 days in the compression and no compression groups, respectively (p = .28). Complications throughout the six month follow up were comparable between groups, although skin rash/blisters occurred more often in the compression group (p = .01). CONCLUSION After treating C2-C4 varicose veins with RFA and concomitant foam sclerotherapy, no post-operative compression was non-inferior to post-operative compression, in terms of safety and efficacy. ClinicalTrials.gov Identifier: NCT02890563.
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Affiliation(s)
- Toni Pihlaja
- Department of Vascular Surgery, Oulu University Hospital, Finland; Medical Research Centre Oulu, University of Oulu, Oulu, Finland.
| | - Pekka Romsi
- Department of Vascular Surgery, Oulu University Hospital, Finland
| | - Pasi Ohtonen
- Medical Research Centre Oulu, University of Oulu, Oulu, Finland; Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Janne Jounila
- Department of Surgery, Raahe Regional Hospital, Finland
| | - Matti Pokela
- Department of Vascular Surgery, Oulu University Hospital, Finland
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Chou JH, Chen SY, Chen YT, Hsieh CH, Huang TW, Tam KW. Optimal duration of compression stocking therapy following endovenous thermal ablation for great saphenous vein insufficiency: A meta-analysis. Int J Surg 2019; 65:113-119. [PMID: 30959134 DOI: 10.1016/j.ijsu.2019.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/16/2019] [Accepted: 03/27/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The need for patients to wear compression stockings after varicose vein surgery and the duration of compressions tocking therapy has been debated. This study isa meta-analysis of randomized controlled trials (RCTs) to determine the optimal duration of compression stocking therapy after endovenous thermal ablation (ETA) of the great saphenous vein. METHODS The PubMed, Embase, and Cochrane Library databases were searched before January 2019. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate the pooled effect size by using a random effects model. The primary outcome was the severity of pain in the postoperative period. Secondary outcomes were quality of life (QoL), leg volume, bruising scores, consumptionof analgesic agents, recovery time off work, satisfaction, and the incidence rates of postoperative complications including paresthesia and phlebitis. RESULTS Five RCTsinvolving775 patients were reviewed. The long-duration (1-2 weeks) group significantly reduced postoperative pain at 1 week (mean difference [MD] 1.19; 95% confidence interval [CI]: 0.58-1.80) and recovery time off work (MD: 1.01 day, 95% CI: 0.06-1.96)when compared with the short-duration (24-48 h) group. However, the mean pain scores at 2 (0.1; 95% CI: 0-0.2) and 6 weeks postoperatively (-0.3; 95% CI: -1.09-0.49) did not differ significantly between the two groups. Moreover, the incidence rates of complication, paresthesia, and phlebitis did not differ significantly between the short-duration and long-duration groups. CONCLUSION The use of compression therapy for a long time (1-2 weeks) is better than short-term (24-48 h) use in terms of postoperative pain at 1 week and recovery off work. Hence, we recommend the prescription of 1-week compression stocking therapy after ETA in routine clinical practice. However, the available evidence is of variable quality, further well-structured RCTs with improved standardization of compression treatment, types of stockings, and target populations are warranted.
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Affiliation(s)
- Jian-Hong Chou
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shiaun-Yeu Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Ting Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Compression therapy after invasive treatment of superficial veins of the lower extremities: Clinical practice guidelines of the American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology. J Vasc Surg Venous Lymphat Disord 2019; 7:17-28. [DOI: 10.1016/j.jvsv.2018.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Al Shakarchi J, Wall M, Newman J, Pathak R, Rehman A, Garnham A, Hobbs S. The role of compression after endovenous ablation of varicose veins. J Vasc Surg Venous Lymphat Disord 2018; 6:546-550. [DOI: 10.1016/j.jvsv.2018.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 01/27/2018] [Indexed: 10/17/2022]
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20
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Compression versus No Compression after Endovenous Ablation of the Great Saphenous Vein: A Randomized Controlled Trial. Ann Vasc Surg 2017; 38:72-77. [DOI: 10.1016/j.avsg.2016.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/31/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022]
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21
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Post-operative Benefit of Compression Therapy after Endovenous Laser Ablation for Uncomplicated Varicose Veins: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg 2016; 52:847-853. [DOI: 10.1016/j.ejvs.2016.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/09/2016] [Indexed: 11/22/2022]
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