Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices

Abstract

BACKGROUND: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS), radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). Compared with conventional surgery (high ligation and stripping (HL/S)), proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL) scores, reduced need for general anaesthesia and equivalent recurrence rates. OBJECTIVE: To review available randomized controlled clinical trials (RCT) data comparing USGFS, RFA, EVLT to HL/S for the treatment of great saphenous varicose veins. METHODS: Search methods: The Cochrane Peripheral Vascular Diseases (PVD) Group searched their Specialized Register (July 2010) and CENTRAL (The Cochrane Library 2010, Issue 3). In addition the authors performed a search of EMBASE (July 2010). Manufacturers of EVLT, RFA and sclerosant equipment were contacted for trial data. Selection criteria: All RCTs of EVLT, RFA, USGFS and HL/S were considered for inclusion. Primary outcomes were recurrent varicosities, recanalization, neovascularization, technical procedure failure or need for reintervention, patient quality of life (QoL) scores and associated complications. Secondary outcomes were type of anaesthetic, procedure duration, hospital stay and cost. Data collection and analysis: CN, RE, VB, PC, HB and GS independently reviewed, assessed and selected trials which met the inclusion criteria. CN and RE extracted data. The Cochrane Collaboration's tool for assessing risk of bias was used. CN contacted trial authors to clarify details. MAIN RESULTS: Thirteen reports from five studies with a combined total of 450 patients were included. Rates of recanalization were higher following EVLT compared with HL/S, both early (within four months) (5/149 versus 0/100; odds ratio (OR) 3.83, 95% confidence interval (CI) 0.45 to 32.64) and late recanalization (after four months) (9/118 versus 1/80; OR 2.97; 95% CI 0.52 to 16.98), although these results were not statistically significant. Technical failure rates favoured EVLT over HL/S (1/149 versus 6/100; OR 0.12, 95% CI 0.02 to 0.75). Recurrence following RFA showed no difference when compared with surgery. Recanalization within four months was observed more frequently following RFA compared with HL/S although not statistically significant (4/105 versus 0/88; OR 7.86, 95% CI 0.41 to 151.28); after four months no difference was observed. Neovascularization was observed more frequently following HL/S compared with RFA, but again this was not statistically significant (3/42 versus 8/51; OR 0.39, 95% CI 0.09 to 1.63). Technical failure was observed less frequently follow

Perioperative quality assessment of varicose vein surgery

“…This is consistent with the results of randomized, controlled studies comparing RFA or ELT to open surgery [11,12] and with the Cochrane database analysis [13]; it is also reflected in the latest recommendations of the American Venous Forum [14] and the European Society for Vascular Surgery [15].…”

“…(2) No VVablation procedure should be performed without prior imaging. Color-coded duplex ultrasound (DU) should be used as the preferred method (12,13).…”

Lower pain and faster treatment with mechanico-chemical endovenous ablation using ClariVein®

“…[6][7][8] There is a complication rate of 17-20% [9][10][11] which rises to 40% if this is for recurrent varicose veins. 12,13 Typical return-to-work times have been reported as 10-14 days with bruising lasting up to six weeks. 12,14 Goldman 1 and Rasmussen et al 15 first reported the use radiofrequency ablation (RFA) to treat incompetence of the saphenofemoral junction in 2000, followed a year later by Min et al 3 and Elias and Raines 16 who described the use of endovenous laser treatment (EVLT) to treat truncal veins.…”

The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation

“…1,2 Therefore, the need for thorough research on complications, recurrence rates, and relevant anatomy becomes greater. Many publications have established the role of EVA for ablation of the great saphenous vein, [3][4][5] but studies on EVA of the SSV are still scarce. Short-term and midterm results are promising and show low recurrence rates and fewer complications with EVA than with conventional surgery.…”