A systematic review and meta-analysis on the role of varicosity treatment in the context of truncal vein ablation

Lane, Tristan; Onida, Sarah; Gohel,; Franklin, Ian J.; Davies, AH

doi:10.1177/0268355514548473

Cited by 15 publications

(10 citation statements)

References 37 publications

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“…On the other hand, treating every patient with concomitant branch therapy may be overtreating a number of patients in whom the dilated tributaries would regress if given time and may increase risk of venous thrombotic events. 21 Like the previous CAC trials, the WAVES protocol did not allow adjunctive tributary treatment at the time of saphenous vein closure to prevent confounding of assessments of pain, QOL, and AEs. All patients, therefore by nature of the protocol underwent staging of any necessary tributary procedures.…”

Section: Discussionmentioning

confidence: 99%

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Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study)

et al. 2018

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Purpose Studies examining cyanoacrylate closure of saphenous veins with the VenaSeal™ System have not allowed concomitant procedures for tributaries at the time of the index procedure. Outside of clinical trials, however, concomitant procedures are frequently performed in conjunction with endovenous ablation. We report on the frequency of need for saphenous tributary treatment three months after cyanoacrylate closure of the treatment of great saphenous vein, small saphenous vein, and/or accessory saphenous vein. Methods Fifty subjects with symptomatic great saphenous vein, small saphenous vein, and/or accessory saphenous vein incompetence were treated with no postprocedure compression stockings. Concomitant procedures were not allowed. Treating physicians predicted the type and nature of any concomitant procedures that they would usually perform at the time of ablation, if not limited by the constraints of the study. Evaluations were performed at one week, one and three months and included duplex ultrasound, numeric pain rating scale, revised venous clinical severity score, the Aberdeen Varicose Vein Questionnaire, and time to return to work and normal activities. At the three-month visit, the need for and type of adjunctive procedures were recorded. Results Complete closure at three months was achieved in 70 (99%) of the treated veins (48 great saphenous veins, 14 accessory saphenous veins, eight small saphenous veins). Revised venous clinical severity score improved from 6.4 ± 2.2 to 1.8 ± 1.5 (P < .001) and Aberdeen Varicose Vein Questionnaire from 17.3 ± 7.9 to 6.5 ± 7.2 (P < .0001). Sixty-six percent of patients underwent tributary treatment at three months. The percentage of patients who required adjunctive treatments at three months was lower than had been predicted by the treating physicians (65% versus 96%, p=.0002). Conclusions Closure rates were high in the absence of the use of compression stockings or side branch treatment. Improvement in quality of life was significant, and the need for and extent of concomitant procedures was significantly less than had been predicted by the treating physicians.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study)

et al. 2018

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“…Concomitant treatment of varicosities leads to better gains in QoL in the first three months after treatment compared to delayed treatment with no significant difference in number of further procedures for varicosities. 20 This could influence to the utility gain only in the early period, but not to the cost and should not affect much to the results. Adjusted analysis with concomitant treatment of varicosities also found no significant association of this variable to utility in our study (p ¼ 0.693).…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of great saphenous vein ablation with radiofrequency, foam and surgery in the emerging health-care setting of Thailand

et al. 2016

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“…31 The results of small randomized trials have been conflicting, but a meta-analysis of four comparative studies evaluating the timing of tributary intervention showed a non-significant trend towards fewer procedures among those undergoing simultaneous tributary intervention (Odds ratio 0.734, p ¼ 0.339), although heterogeneity was very high (I 2 81%). 34 Disease-specific quality of life was, however, significantly improved at 6 weeks, but not at 12 weeks, in those undergoing simultaneous treatment. Although confounded by the variable use of general anesthesia, there does not appear to be any difference in venous thrombotic complications between the two strategies.…”

Section: Adjuncts To Effective Vein Carementioning

confidence: 93%

“…35 This ultimately led to several classification schemes for such thrombus extensions. 36 However, rates of thrombotic complications have progressively fallen as experience with these techniques has accumulated, 34 such that recent literature suggests rates of DVT, PE, and EHIT in as low as 0.2%, 0.1%, and 0.5-0.8%, respectively. 37 Most of these thrombi are small, asymptomatic, and resolve relatively rapidly, suggesting that they represent direct extension from an area of injury rather than true systemic activation of coagulation.…”

Section: Adjuncts To Effective Vein Carementioning

confidence: 99%

What is effective care for varicose veins?

Meissner

2016

Phlebology

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Varicose veins affect one-quarter to one-third of Western adult populations and consume an increasing amount of health care resources. Much of this increased utilization has been driven by the advent of minimally invasive technology including endovenous thermal ablation, foam sclerotherapy, and more recently mechanicochemical and cyanoacrylate glue ablation. This has largely been driven by patient and physician preferences in the absence of robust evidence that one therapy is truly superior to another. This partially arises from misunderstandings about appropriate outcomes measures and what truly constitutes effective treatment of varicose veins. Technical outcomes, such as saphenous closure rates, have frequently been used as surrogates for effective treatment but are poorly correlated with symptom improvement, quality of life, and risk of recurrence. Although there does appear to be a trend towards higher recurrence with ultrasound-guided foam sclerotherapy, the data are occasionally conflicting and there does not appear to be substantial differences between the various modalities. Similarly, there do not appear to be major differences in late quality of life measures between these treatment options. As long-term differences in recurrence and quality of life are small, overall cost effectiveness is driven primarily by initial treatment costs and ultrasound-guided foam sclerotherapy is the most cost-effective strategy in many models. However, there continues to be substantial uncertainty surrounding cost estimates and other factors of importance to the patient may ultimately drive treatment decisions. The benefits of some adjuncts to the treatment of axial superficial reflux, such as the concurrent versus staged management of tributary varicosities, remain ill-defined while that of others, such as routine post-procedural ultrasound surveillance and compression, need critical re-evaluation.

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A systematic review and meta-analysis on the role of varicosity treatment in the context of truncal vein ablation

Abstract: The evidence base regarding timing of varicosity treatment is sparse; however, it does show that simultaneous treatment of varicosities leads to early gains in quality of life, with a non-significant trend for fewer further procedures but more venous thrombotic events.

Cited by 15 publications

References 37 publications

Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study)

Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study)

Cost-utility analysis of great saphenous vein ablation with radiofrequency, foam and surgery in the emerging health-care setting of Thailand

What is effective care for varicose veins?

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