A review of a new Dutch guideline for management of recurrent varicose veins

Abstract

In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.

Ultrasound Guided Foam Sclerotherapy as a Preferred Treatment Option for Varicose Veins in Terms of Safety, Efficacy and Cost Effectiveness

“…Redo UGFS is simple and easier than redo surgery, RFA, or EVLT 20 . Treating perforating veins by UGFS also require UGFS of above knee great saphenous vein, even if it is competent 21 .…”

Evidence of Foam Sclerotherapy in the Treatment of Recurrent Varicose Veins

“…Increasing recanalisation rates in the long term can be easily and successfully treated by repeat interventions which is a hallmark of UGFS technique and sets it apart from surgery. If repeat intervention is taken into account, technical success rates close to those reported for endothermal ablation techniques of up to 100 % can be achieved (reviewed in [26]). However, superior outcomes reported for RFA/EVLA disregard the limitations of catheter-based techniques that are particularly apposite to RVV (tortuous, thinwalled, scarred, low-diameter veins), and consequently result in the exclusion of a high proportion of varicose sites.…”

“…[23][24][25]. The apparent gap in evidence-based recommendations is a consequence of an underrepresentation of decent studies dedicated to RVV treatment, a drawback that becomes even more problematic when it comes to UGFS-based therapy [26].…”

Обгрунтування Показань І Вибір Способу Хірургічного Лікування Хворих На Рецидив Варикозної Хвороби Нижніх Кінцівок

“…На даний час застосовують три основні способи лікування РВХ -відкриті хірургічні втручання, ендовазальну лазерну абляцію (ЕВЛА) і хімічну (склеротерапія) абляцію вен [4]. Залежно від анатомічних особливостей варикозних змін підшкірних вен і навколишніх тканин кожен із способів має суворі показання та протипоказання, може застосовуватися як самостійно, так і в комплексі з іншими способами.…”