Endovenous Laser Treatment for Varicose Veins in Patients with Active Ulcers: Measurement of Intravenous and Perivenous Temperatures during the Procedure

Viarengo, Luiz Marcelo Aiello; Potério-Filho, João; Potério, Glória Maria Braga; Menezes, Fábio Hüsemann; Meirelles, Guilherme Vieira

doi:10.1111/j.1524-4725.2007.33259.x

Cited by 40 publications

(36 citation statements)

References 18 publications

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“…Values in parentheses are 95 per cent confidence intervals.*Based on results of RCTs10 12 of low methodological quality. QALY, quality‐adjusted life‐year; UGFS, ultrasound‐guided foam sclerotherapy; EVLA, endovenous laser ablation.…”

Section: Resultsmentioning

confidence: 99%

“…1·65 to 6·98). Furthermore, in the 22 patients with a healed ulcer following EVLA, there were no cases of recurrence of ulceration, whereas with compression therapy alone there were four recurrences in nine healed patients (RR 0·03, 0·00 to 0·58)10. However, the Cochrane group11 excluded this study for poor methodological quality, and thus it was not included in the base case model.…”

Section: Methodsmentioning

confidence: 99%

“…Analysis of co‐variance was used to identify the input parameters that most explained the overall variance in difference in costs and QALYs predicted by the model30. Exploratory analyses were also conducted to evaluate the cost‐effectiveness of EVLA and UGFS, using the effectiveness estimates from Viarengo et al 10. and O'Hare and Earnshaw12.…”

Section: Methodsmentioning

confidence: 99%

“…However, there is very little RCT evidence about their effectiveness in treating venous leg ulcers. One RCT10 has been conducted for EVLA, which was found to be more effective than compression for both healing and preventing recurrence. This trial was included in the systematic review by Mauck and colleagues7, but was considered to be of insufficient methodological quality to be included in the Cochrane review11.…”

Section: Introductionmentioning

confidence: 99%

“…The primary (base case) study compared superficial venous surgery with compression. Scenario analyses incorporated the limited evidence from other interventional procedures, including EVLA10 and UGFS12.…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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BackgroundVenous leg ulcers impair quality of life significantly, with substantial costs to health services. The aim of this study was to estimate the cost‐effectiveness of interventional procedures alongside compression therapy versus compression therapy alone for the treatment of chronic venous leg ulceration.MethodsA Markov decision analytical model was developed. The main outcome measures were quality‐adjusted life‐years (QALYs) and lifetime costs per patient, from the perspective of the UK National Health Service at 2015 prices. Resource use included the initial procedures, compression therapy, primary care and outpatient consultations. The interventional procedures included superficial venous surgery, endothermal ablation and ultrasound‐guided foam sclerotherapy (UGFS). The study population was patients with a chronic venous ulcer who were eligible for either compression therapy or an interventional procedure. Data were obtained from systematic review and meta‐analysis of RCTs.ResultsSurgery gained 0·112 (95 per cent c.i. −0·011 to 0·213) QALYs compared with compression therapy alone, with a difference in lifetime costs of €−1330 (−3570 to 1262). Given the expected savings in community care, the procedure would pay for itself within 4 years. There was insufficient evidence regarding endothermal ablation and UGFS to draw conclusions.DiscussionThis modelling study found surgery to be more effective and less costly than compression therapy alone. Further RCT evidence is required for both endothermal ablation and UGFS.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

et al. 2018

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

Nesbitt

Bedenis

Bhattacharya³

et al. 2011

Cochrane Database of Systematic Reviews

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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

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Endovenous thermal ablation for healing venous ulcers and preventing recurrence

Samuel

Carradice

Wallace

et al. 2013

Cochrane Database of Systematic Reviews

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Endovenous Laser Treatment for Varicose Veins in Patients with Active Ulcers: Measurement of Intravenous and Perivenous Temperatures during the Procedure

Abstract: The treatment for varicose veins with EVL is safe in patients with active ulcers. Wounds healed faster than in patients undergoing clinical treatment alone during a 1-year period. There was no ulcer recurrence in patients treated with EVL.

Cited by 40 publications

References 18 publications

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

Cost‐effectiveness of treatments for superficial venous reflux in patients with chronic venous ulceration

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

Endovenous thermal ablation for healing venous ulcers and preventing recurrence

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