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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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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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Cartee TV, Wirth P, Greene A, Straight C, Friedmann DP, Pittman C, Daugherty SF, Blebea J, Meissner M, Schul MW, Mishra V. Ultrasound-guided foam sclerotherapy is safe and effective in the management of superficial venous insufficiency of the lower extremity. J Vasc Surg Venous Lymphat Disord 2021; 9:1031-1040. [PMID: 34144767 DOI: 10.1016/j.jvsv.2021.03.020] [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] [Received: 08/03/2020] [Accepted: 03/31/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Superficial venous disease of the lower extremity has a significant impact on quality of life. Both truncal and tributary vein reflux contribute to this disease process. Endovenous foam sclerotherapy is a widely used technique throughout the world for the management of superficial venous reflux and ultrasound guidance improves its safety and efficacy. METHODS A PubMed search for ultrasound-guided foam sclerotherapy (UGFS) was conducted and all abstracts were reviewed to identify clinical trials and systematic reviews for a full-text analysis. Additional articles were also identified through searching the references of the selected studies. RESULTS The production of foam for sclerotherapy in a 1:3 or 1:4 ratio of air to sclerosant is optimal in a low silicone, low-volume syringe system. Physiologic gas may decrease any side effects, with the trade-off of decreased foam stability. Proper technique with appropriate sterility and cleansing protocols are paramount for safe and effective treatment. The technical success of UGFS for great saphenous vein disease is inferior to endothermal and surgical modalities and retreatment is more common. However, the clinical improvement in patient-reported quality of life is similar between these three modalities. When used for tributary veins in combination with endothermal approaches of the truncal veins, UGFS has high rates of success with excellent patient satisfaction. UGFS has demonstrated an excellent safety profile comparable with or superior to other modalities. CONCLUSIONS With proper technique, UGFS is safe and effective for the management of superficial venous disease.
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Affiliation(s)
- Todd V Cartee
- Department of Dermatology, Penn State Health, Hershey, Pa.
| | - Paul Wirth
- Department of Dermatology, Penn State Health, Hershey, Pa
| | - Amrit Greene
- Department of Dermatology, Penn State Health, Hershey, Pa
| | | | | | - Chris Pittman
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, Fla; Vein911 Vein Treatment Centers, Tampa, Fla
| | | | - John Blebea
- Department of Surgical Disciplines, Central Michigan University College of Medicine, Mount Pleasant, Mich
| | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Marlin W Schul
- Indiana University School of Medicine, West Lafayette campus, Lafayette, Ind; Indiana Vascular Associates, LLC, Lafayette, Ind
| | - Vineet Mishra
- Division of Mohs Surgery, Dermatology & Vascular Surgery, Scripps Clinic, San Diego, Calif
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5
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Dattani N, Shalhoub J, Nandhra S, Lane T, Abu-Own A, Elbasty A, Jones A, Duncan A, Garnham A, Thapar A, Murray A, Baig A, Saratzis A, Sharif A, Huasen B, Dawkins C, Nesbitt C, Carradice D, Morrow D, Bosanquet D, Kavanagh E, Shaikh F, Gosi G, Ambler G, Fulton G, Singh G, Travers H, Moore H, Olivier J, Hitchman L, O’Donohoe M, Popplewell M, Medani M, Jenkins M, Goh MA, Lyons O, McBride O, Moxey P, Stather P, Burns P, Forsythe R, Sam R, Brar R, Brightwell R, Benson R, Onida S, Paravastu S, Lambracos S, Vallabhaneni SR, Walsh S, Aktar T, Moloney T, Mzimba Z, Nyamekye I. Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study. Phlebology 2020; 35:706-714. [DOI: 10.1177/0268355520936420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus. Methods A 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively. Results Forty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements. Conclusions The main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.
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Affiliation(s)
- Nikesh Dattani
- Worcestershire Acute Hospitals NHS Trust, The Vascular Surgery Unit, Worcester, Worcestershire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Joseph Shalhoub
- Imperial College Healthcare NHS Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sandip Nandhra
- Northern Vascular Centre, Freeman Hospital, Newcastle University, Newcastle Upon Tyne, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tristan Lane
- Department of Surgery and Cancer, Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Abdulsalam Abu-Own
- Colchester Hospital University NHS Foundation Trust, Colchester, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ahmed Elbasty
- Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Aled Jones
- Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Andrew Duncan
- University Hospitals of Leicester NHS Trust, Leicester, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Andrew Garnham
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ankur Thapar
- Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Anna Murray
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Anzar Baig
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Athanasios Saratzis
- University Hospitals of Leicester NHS Trust, Leicester, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Atif Sharif
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Bella Huasen
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Claire Dawkins
- Sunderland Royal Hospital, Sunderland, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Craig Nesbitt
- Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Daniel Carradice
- Hull Royal Infirmary, Hull, Kingston upon Hull, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Darren Morrow
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - David Bosanquet
- Southmead Hospital, Bristol, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Eamon Kavanagh
- University of Limerick Hospitals Group, Vascular Surgery, Limerick, Ireland
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Faisal Shaikh
- Heartlands Hospital, Birmingham, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gergely Gosi
- University Hospital Waterford, Vascular Surgery, Waterford, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Graeme Ambler
- Royal Gwent Hospital, Newport, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gregory Fulton
- Cork University Hospital Group, Cork, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gurdas Singh
- Guy’s Hospital, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Hannah Travers
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Hayley Moore
- Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - James Olivier
- Musgrove Park Hospital, Taunton, Somerset, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Louise Hitchman
- Hull Royal Infirmary, Hull, Kingston upon Hull, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Martin O’Donohoe
- Mater Misericordiae University Hospital, Dublin, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Matthew Popplewell
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Mekki Medani
- Beaumont Hospital, Dublin, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Michael Jenkins
- Imperial College Healthcare NHS Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Mingzheng A Goh
- Basildon University Hospital, Basildon, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Oliver Lyons
- Basildon University Hospital, Basildon, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Olivia McBride
- Edinburgh Royal Infirmary, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Paul Moxey
- St George’s Hospital, Vascular Surgery, London, Tooting, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Philip Stather
- Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Phillipa Burns
- Edinburgh Royal Infirmary, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Rachel Forsythe
- Royal Infirmary of Edinburgh, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Rachel Sam
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ranjeet Brar
- Royal Free London NHS Foundation Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Robert Brightwell
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ruth Benson
- University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sarah Onida
- Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sharath Paravastu
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Simon Lambracos
- Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Srinivasa R Vallabhaneni
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Stewart Walsh
- Lambe Institute for Translational Discipline of Surgery, National University of Ireland, Galway, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tasleem Aktar
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tony Moloney
- University of Limerick Hospitals Group, Dooradoyle, Limerick, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Zola Mzimba
- Altnagelvin Hospitals Health and Social Services Trust, Londonderry, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Isaac Nyamekye
- Worcestershire Acute Hospitals NHS Trust, The Vascular Surgery Unit, Worcester, Worcestershire, 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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Kürşat Bozkurt A, Lawaetz M, Danielsson G, Lazaris AM, Pavlovic M, Olariu S, Rasmussen L. European College of Phlebology guideline for truncal ablation. Phlebology 2019; 35:73-83. [DOI: 10.1177/0268355519857362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background The purpose of the guideline was to achieve consensus in the care and treatment of patients with chronic venous disease, based on current evidence. Method A systematic literature search was performed in PubMed, Embase, Cinahl, and the Cochrane library up until 1 February 2019. Additional relevant literature were added through checking of references. Level of evidence was graded through the GRADE scale and recommendations were concluded. Results For the treatment of great and small saphenous vein reflux, endovenous ablation with laser or radiofrequency was recommended in preference to surgery or foam sclerotherapy. If tributaries are to be treated it should be done in the same procedure. Treatment with mecanicochemical ablation and glue can be used but we still need long term follow up results. Conclusion For the treatment of truncal varicosities, endovenous ablation with laser or radiofrequency combined with phlebectomies is recommended before surgery or foam.
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Affiliation(s)
- A Kürşat Bozkurt
- Department of Cardiovascular Surgery, Istanbul University – Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Martin Lawaetz
- Rigshospitalet, Department of Vascular Surgery, Copenhagen, Denmark
- The Danish Vein Centers, Naestved, Denmark
| | | | - Andreas M Lazaris
- Department of Vascular Surgery, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Milos Pavlovic
- Infinity Family Medicine Clinic, Dubai, United Arab Emirates
| | - Sorin Olariu
- Victor Babes University of Medicine and Pharmacy of Timisoara
- UMFT, Surgery 1st, Timişoara, Romania
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8
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Oliveira RDÁ, Mazzucca ACP, Pachito DV, Riera R, Baptista-Silva JCDC. Evidence for varicose vein treatment: an overview of systematic reviews. SAO PAULO MED J 2018; 136:324-332. [PMID: 30020324 PMCID: PMC9881696 DOI: 10.1590/1516-3180.2018.0003240418] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/24/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Varicose veins affect nearly 30% of the world's population. This condition is a social problem and needs interventions to improve quality of life and reduce risks. Recently, new and less invasive methods for varicose vein treatment have emerged. There is a need to define the best treatment options and to reduce the risks and costs. Since there are cosmetic implications, treatments for which effectiveness remains unproven present risks to consumers and higher costs for stakeholders. These risks and costs justify conducting an overview of systematic reviews to summarize the evidence. DESIGN AND SETTING Overview of systematic reviews within the Discipline of Evidence-Based Health, at Universidade Federal de São Paulo (UNIFESP). METHODS Systematic reviews on clinical or surgical treatments for varicose veins were included, with no restrictions on language or publication date. RESULTS 51 reviews fulfilled the inclusion criteria. Outcomes and comparators were described, and a narrative review was conducted. Overall, there was no evidence that compression stockings should be recommended for patients as the initial treatment or after surgical interventions. There was low to moderate evidence that minimally invasive therapies (endovenous laser therapy, radiofrequency ablation or foam sclerotherapy) are as safe and effective as conventional surgery (ligation and stripping). Among these systematic reviews, only 18 were judged to present high quality. CONCLUSIONS There was evidence of low to moderate quality that minimally invasive treatments, including foam sclerotherapy, laser and radiofrequency therapy are comparable to conventional surgery, regarding effectiveness and safety for treatment of varicose veins.
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Affiliation(s)
- Ricardo de Ávila Oliveira
- MD, MSc. Vascular Surgeon, Adjunct Professor, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), and Postgraduate Student in the Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Andréa Castro Porto Mazzucca
- BSc. Pharmacist and Postgraduate Student in the Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Daniela Vianna Pachito
- MD, MSc. Neurologist and Postgraduate Student in the Evidence-Based Health Program, Universidade Federal de São Paulo, (UNIFESP), São Paulo (SP), Brazil.
| | - Rachel Riera
- MD, PhD. Rheumatologist, Assistant Professor of the Discipline of Evidence-based Health, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), and Assistant Coordinator at Cochrane Brazil, São Paulo (SP), Brazil.
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9
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Cavezzi A, Mosti G, Colucci R, Quinzi V, Bastiani L, Urso SU. Compression with 23 mmHg or 35 mmHg stockings after saphenous catheter foam sclerotherapy and phlebectomy of varicose veins: A randomized controlled study. Phlebology 2018; 34:98-106. [DOI: 10.1177/0268355518776127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To compare two different medical compression stockings after varicose vein treatment. Patients and methods A randomized single-blind controlled study on two compression regimes after saphenous catheter foam sclerotherapy + phlebectomy was performed. After pads and 5 mmHg contention sock, 23 mmHg (group A, Struva 23®) or 35 mmHg (group B, Struva 35®) medical compression stocking was applied 24 h/day for seven days; subsequently 21–23 mmHg medical compression stocking in daytime. Symptoms, compliance, skin findings, and bioimpedance spectroscopy parameters were assessed. Results A total of 94 patients (48 and 49 limbs in groups A and B, respectively) were enrolled. Three (T3) and seven (T7) days post-operatively, most symptoms were significantly milder in group B, especially pain and heaviness at T7 and at day 40 (T40). Ambulation, medical compression stocking stability/tolerability and skin healing were significantly better in group B, with p = 0.046, 0.021/0.060, and 0.010, respectively, at T7. Bioimpedance parameters increased at T7 and decreased at T40 in both groups; leg reactance and limb L-Dex improved in group B at T7 and T40, respectively (p = 0.039 and 0.012). Conclusions Compression with 23 and 35 mmHg medical compression stocking after catheter foam sclerotherapy + phlebectomy was effective and well tolerated at immediate/short term. Compression with 35 mmHg medical compression stocking provided less adverse post-operative symptoms and better tissue healing. Bioimpedance results confirmed a slightly better edema improvement with 35 mmHg medical compression stocking.
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Affiliation(s)
| | | | | | | | - Luca Bastiani
- Institute of Clinical Physiology, Italian National Research Council, CNR, Pisa, Italy
| | - Simone U Urso
- Eurocenter Venalinfa, S. Benedetto del Tronto (AP), Italy
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Estado actual de las técnicas endoablativas en el tratamiento de la insuficiencia venosa superficial. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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