A Randomized Trial Comparing Treatments for Varicose Veins

Brittenden, Julie; Cotton, Seonaidh; Elders, Andrew; Ramsay, Craig R; Norrie, John; Burr, Jennifer; Campbell, Bruce; Bachoo, Paul; Chetter, Ian; Gough, Michael; Earnshaw, J. J.; Lees, Tim; Scott, Julian; Baker, Sara A; Francis, Jill J; Tassie, Emma; Scotland, Graham; Wileman, Samantha; Campbell, Marion K

doi:10.1056/nejmoa1400781

Cited by 178 publications

(61 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The largest trial comparing surgery, EVLA and UGFS in the treatment of GSV reflux included 798 patients, of whom 84 per cent completed 6 months of follow‐up9. In this series the complete success rate after 6 months was 78, 82 and 43 per cent respectively in the surgery, EVLA and UGFS groups.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins

Venermo

Saarinen

Eskelinen

et al. 2016

Journal of British Surgery

View full text Add to dashboard Cite

BackgroundEndovenous ablation techniques and ultrasound‐guided foam sclerotherapy (UGFS) have largely replaced open surgery for treatment of great saphenous varicose veins. This was a randomized trial to compare the effect of surgery, endovenous laser ablation (EVLA) (with phlebectomies) and UGFS on quality of life and the occlusion rate of the great saphenous vein (GSV) 12 months after surgery.MethodsPatients with symptomatic, uncomplicated varicose veins (CEAP class C2–C4) were examined at baseline, 1 month and 1 year. Before discharge and at 1 week, patients reported a pain score on a visual analogue scale. Preoperative and 1‐year assessments included duplex ultrasound imaging and the Aberdeen Varicose Vein Severity Score (AVVSS).ResultsThe study included 214 patients: 65 had surgery, 73 had EVLA and 76 had UGFS. At 1 year, the GSV was occluded or absent in 59 (97 per cent) of 61 patients after surgery, 71 (97 per cent) of 73 after EVLA and 37 (51 per cent) of 72 after UGFS (P < 0·001). The AVVSS improved significantly in comparison with preoperative values in all groups, with no significant differences between them. Perioperative pain was significantly reduced and sick leave shorter after UGFS (mean 1 day) than after EVLA (8 days) and surgery (12 days).ConclusionIn comparison with open surgery and EVLA, UGFS resulted in equivalent improvement in quality of life but significantly higher residual GSV reflux at 12‐month follow‐up.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The primary outcome measures were: 1‐year occlusion (or absence) rate of GSV on routine duplex imaging, and changes in disease‐specific quality of life according to the Aberdeen Varicose Vein Severity Score (AVVSS)9. The diameter of the GSV 20 cm below the groin was also measured and compared with preoperative values.…”

Section: Methodsmentioning

confidence: 99%

Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins

Venermo

Saarinen

Eskelinen

et al. 2016

Journal of British Surgery

View full text Add to dashboard Cite

show abstract

“…In a comprehensive meta-analysis of 104 articles including more than 11,000 patients, we found an anatomic closure rate of 85%, with 91% of patients reporting reduction in vein-related symptoms [4]. There are few randomized comparative trials to thermal-based ablation, however, EFS in recent studies shows equal efficacy with few adverse effects [11]. Recently, there has been emphasis on assessment of improvement in venous symptoms and quality of life after EFS rather than vein closure.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of Clinical Characteristics and Biomarkers after Endovenous Foam Sclerotherapy for Venous Disorders

Rathbun¹,

Ryan²,

er³

et al. 2016

J Clin Trials

View full text Add to dashboard Cite

Objective: Endovenous foam sclerotherapy (EFS) is widely performed in the U.S, but there is a paucity of studies evaluating clinical predictors of outcomes, including biomarkers, in patients with venous disorders. Methods:Patients undergoing EFS monotherapy for venous disorders were enrolled. Evaluation at baseline, 1 week, 12 weeks, and 26 weeks included clinical characteristics and biomarker analysis.Results: 100 patients with venous disease were treated. At one week follow-up, 44% underwent a second injection. At 3 months, 100% of patients had obliteration of at least 80% of their affected veins, and 96% reported improved venous stasis symptoms. Adverse events were minor and deep vein thrombosis was found 4 patients at 3 months. D-dimer levels were significantly higher at week one, but returned to baseline by week 12; fibrin monomer decreased and PPL increased at one week and 3 months relative to baseline. Conclusion:EFS monotherapy is effective in treating signs and symptoms of venous disease with few adverse effects. D-dimer levels are significantly associated with obliteration of venous segments suggesting an association between vein obliteration and activation of coagulation.

show abstract

“…7 Overall, patients experience improved Clinical, Etiology, Anatomy and Pathophysiology (CEAP) class, Venous Clinical Severity Score (VCSS), and Patient Reported Outcomes (PROs), suggesting that these procedures be an important tool for providers in the treatment of varicose veins. 7–9 However, there is a paucity of data describing age related benefit to varicose vein procedures despite overwhelming evidence to suggest the prevalence of varicose veins increases with age. 3, 4 …”

Section: Introductionmentioning

confidence: 99%

Age is not a barrier to good outcomes after varicose vein procedures

Sutzko

Andraska

Andrea

et al. 2017

Journal of Vascular Surgery: Venous and Lymphatic Disorders

View full text Add to dashboard Cite

Background The Vascular Quality Initiative Varicose Vein Registry (VQI VVR) represents a patient-centered database launched in January 2015. Previous work describing overall trends and outcomes of varicose vein procedures across the United States demonstrates a benefit from these procedures. The existing gaps in evidence to support current and future Medicare coverage of varicose vein procedures necessitate further description of clinical outcomes in patients ≥ 65 years old compared to the < 65 year old population. Methods This study analyzed prospectively captured anatomic, procedural, and outcome data for all patients in a national cohort of all VQI VVR-participating centers. The VQI VVR database was queried for all patients undergoing varicose vein procedures between January 2015 and July 2016. Pre-procedural and post-procedural CEAP classification, venous clinical severity score (VCSS), and patient reported outcomes (PROs) were compared between patients < 65 and ≥ 65 years old. Univariate descriptive statistics of demographic and procedural data were performed. Student’s t tests were then performed on change in CEAP classification, VCSS score and PROs (heaviness, achiness, throbbing, swelling, itching, appearance and impact on work) for each group. Results There were 4,841 varicose vein procedures performed from January 2015 to May 2016. There were 3,441 procedures performed in 2,691 patients (3631 limbs) in the < 65 years old group and 1,400 procedures performed in 1,068 patients (1467 limbs) in the ≥ 65 years old group. Truncal veins alone were the most common veins treated in both groups. The majority of patients were white and female in both groups. Most of the demographic characteristics were clinically similar, (although statistically different), in both groups with the exception of a higher BMI is the < 65 group and a history of bilateral varicose vein treatment, and anticoagulation being more common among patients ≥ 65. Patients in both groups experience statistically significant improvement in VCSS, PROs and CEAP. There was no difference in overall complications between age groups. Conclusion All patients demonstrated an associated improvement in both clinical outcomes (CEAP, VCSS), and PROs. There was no significant difference in the improvement in CEAP and VCSS between patients less than and greater than 65 years old, although the younger population reported greater improvement in PROs. Given these findings, patients older than 65 appear to benefit from varicose vein procedures and should not be denied interventions on their varicose veins and venous insufficiency based only on their age.

show abstract

A Randomized Trial Comparing Treatments for Varicose Veins

Cited by 178 publications

References 34 publications

Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins

Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins

Evaluation of Clinical Characteristics and Biomarkers after Endovenous Foam Sclerotherapy for Venous Disorders

Age is not a barrier to good outcomes after varicose vein procedures

Contact Info

Product

Resources

About