Economic and Outcomes-Based Analysis of the Care of Symptomatic Varicose Veins

Eidson, Jack L.; Atkins, Marvin D.; Bohannon, W. Todd; Marrocco, Christopher J.; Buckley, Clifford J.; Bush, Ruth L.

doi:10.1016/j.jss.2010.12.027

Cited by 20 publications

(10 citation statements)

References 11 publications

(9 reference statements)

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“…11 Subsequent improvements in both techniques and catheter design have resulted in improved outcomes and a decrease in published rates of thrombotic complications. 12 We noted excellent patient outcomes following endovenous saphenous RFA at a large, tertiary care academic medical center with a patient population trending toward more severe, symptomatic CVI. A large number of studies demonstrating similar patient outcomes following saphenous ablation have been composed of patient cohorts consisting primarily of milder CEAP class 2 disease.…”

Section: Discussionmentioning

confidence: 78%

Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries

Harlander-Locke¹,

Jiménez²,

Lawrence³

et al. 2013

Journal of Vascular Surgery

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The majority of patients with symptomatic chronic venous insufficiency benefit from endovenous RFA of incompetent saphenous veins with comparable results to published surgical outcomes for endovenous closure. The great majority of patients with refluxing tributary veins greater than 3 mm in diameter required phlebectomy in addition to saphenous ablation. These patients may benefit from concomitant phlebectomy along with endovenous saphenous closure.

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Section: Discussionmentioning

confidence: 78%

Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries

Harlander-Locke¹,

Jiménez²,

Lawrence³

et al. 2013

Journal of Vascular Surgery

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“…Across all studies, the occlusion rates at less than 3 months were usually 93%-100%, 11,13,15,25,31,36,37,41 with a weighted average of 98% (weighting was performed according to the number of legs treated in each study). The venous occlusion rate at 6 months was reported as being close to 90% in 4 studies included in the MAS review 20 but appeared to be higher in more recent studies, 98.6%-100%, 8,26,28,35 for a weighted average of 98.8%. Longer-term follow-up results (≥ 1 yr) were rare.…”

Section: Efficacymentioning

confidence: 79%

“…A significantly shorter hospital stay with RFA than with surgery was reported . 35,36 With the exception of 16% of RFA cases in the study by Eidson and colleagues, 35 surgery was performed under general anesthesia, whereas RFA was not.…”

Section: Duration Of Procedure Hospital Admission and Return To Normentioning

confidence: 99%

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Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis

Poder

Fisette

Bédard

et al. 2018

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Background: Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context. Methods:We conducted a systematic literature review (publication date May 2010-September 2013 for articles in English, January 1991-September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing. Results:The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110-$220 more expensive per patient than open surgery. Conclusion:Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility.

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“…Supportive treatments include compression stockings 5-8. Interventional procedures can be performed on an inpatient or outpatient basis, with the latter option being associated with lower costs 9,10.…”

Section: Introductionmentioning

confidence: 99%

Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don't tell, they won't know

Mendes¹,

Martins²,

Fukuda³

et al. 2016

Clinics

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OBJECTIVES:This study compared radiofrequency ablation versus conventional surgery in patients who had not undergone previous treatment for bilateral great saphenous vein insufficiency, with each patient serving as his own control.METHOD:This was a randomized controlled trial that included 18 patients and was carried out between November 2013 and May 2015. Each of the lower limbs of each patient was randomly assigned to undergo either radiofrequency ablation or conventional surgery. Clinical features (hyperpigmentation, hematoma, aesthetics, pain, skin burn, nerve injury, and thrombophlebitis) were evaluated at one week, one month, and six months postoperatively. Hemodynamic assessments (presence of resection or occlusion of the great saphenous vein and recurrent reflux in the sapheno-femoral junction and in the great saphenous vein) were performed at one month, six months, and 12 months postoperatively. The independent observer (a physician not involved in the original operation), patient, and duplex ultrasonographer were not made aware of the treatment done in each case. Clinicaltrials.gov: NCT02588911.RESULTS:Among the clinical variables analyzed, only the aesthetic evaluation by the physicians was significant, with radiofrequency ablation being considered better than conventional surgery (average, 0.91 points higher: standard deviation: 0.31; 95% confidence interval: -1.51, -0.30; p=0.003). However, in our study, we observed primary success rates of 80% for radiofrequency ablation and 100% for conventional surgery.CONCLUSIONS:If the physician is not required to inform the patient as to the technique being performed, the patient will not be able to identify the technique based on the signs and symptoms. Our study revealed that both techniques led to high levels of patient satisfaction, but our results favor the choice of conventional surgery over radiofrequency ablation, as patients who underwent conventional surgery had better hemodynamic assessments.

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Economic and Outcomes-Based Analysis of the Care of Symptomatic Varicose Veins

Cited by 20 publications

References 11 publications

Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries

Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries

Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis

Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don't tell, they won't know

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