Endovenous therapies of lower extremity varicosities: A meta-analysis

Bos, Renate van den; Arends, Lidia R.; Kockaert, Michaël; Neumann, Martino; Nijsten, Tamar

doi:10.1016/j.jvs.2008.06.030

Cited by 459 publications

(357 citation statements)

References 36 publications

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“…24,26,27 Based on these facts, endovenous laser ablation at 1470nm, conducted by homogeneous tissue irradiation (with a radial fiber) with the vein wall as the direct target (chromophore: interstitial water) was indeed a major breakthrough for endolaser techniques, with impacts on minimization of the adverse effects inherent to the technique performed with other types of lasers (808, 810, 940 and 980nm, for example). [9][10][11]20,28 In turn, conducting the technique with a radial fiber and λ = 1940nm is an incremental development of the state-of-the-art in laser thermal ablation.…”

Section: Discussionmentioning

confidence: 99%

“…The fundamental differences between different wavelengths are related to occurrence of adverse events. [9][10][11] From the point of view of physics, the higher a tissue or a chromophore's coefficient of light absorption, the greater the quantity of heat generated and the more confined the zone in which heat is generated. These principles indicate that a 1940nm laser would offer advantages, because it acts on water's second largest absorption peak, theoretically increasing both the efficacy and safety of the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Viarengo¹,

Viarengo²,

Martins³

et al. 2017

J. vasc. bras.

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Resumo Contexto Desde a introdução do laser endovenoso para tratamento das varizes, há uma busca pelo comprimento de onda ideal, capaz de produzir o maior dano seletivo possível com maior segurança e menor incidência de efeitos adversos. Objetivos Avaliar os resultados de médio e longo prazo do laser de diodo de 1940 nm no tratamento de varizes, correlacionando os parâmetros utilizados com a durabilidade do desfecho anatômico. Métodos Revisão retrospectiva de pacientes diagnosticados com insuficiência venosa crônica em estágio clínico baseado em clínica, etiologia, anatomia e patofisiologia (CEAP) C2 a C6, submetidos ao tratamento termoablativo endovenoso de varizes tronculares, com laser com comprimento de onda em 1940 nm com fibra óptica de emissão radial, no período de abril de 2012 a julho de 2015. Uma revisão sistemática dos registros médicos eletrônicos foi realizada para obter dados demográficos e dados clínicos, incluindo dados de ultrassom dúplex, durante o período de seguimento pós-operatório. Resultados A média de idade dos pacientes foi de 53,3 anos; 37 eram mulheres (90,2%). O tempo médio de seguimento foi de 803 dias. O calibre médio das veias tratadas foi de 7,8 mm. A taxa de sucesso imediato foi de 100%, com densidade de energia endovenosa linear (linear endovenous energy density, LEED) média de 45,3 J/cm. A taxa de sucesso tardio foi de 95,1%, com duas recanalizações por volta de 12 meses pós-ablação. Não houve nenhuma recanalização nas veias tratadas com LEED superior a 30 J/cm. Conclusões O laser 1940 nm mostrou-se seguro e efetivo, em médio e longo prazo, para os parâmetros propostos, em segmentos venosos com até 10 mm de diâmetro.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Viarengo¹,

Viarengo²,

Martins³

et al. 2017

J. vasc. bras.

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“…Other important outcomes such as ulceration were rarely reported. Six reviews, [46][47][48]50,51,166 a clinical practice guideline 26 and a cost-effectiveness analysis 136 have been published since 2007 on this topic. One meta-analysis, by Leubke et al, 47 evaluated RFA alone and that by Jia et al 46 evaluated the efficacy and safety of FS alone.…”

Section: Statement Of Principal Findingsmentioning

confidence: 99%

“…The meta-analyses published by Murad et al, 50 Luebke et al 48 and van den Bos et al 167 considered all three principal minimally invasive techniques, as well as LS, but found data only from 9, 12 and 8 relevant RCTs, respectively, with substantial duplication of included studies. Large numbers of observational studies, and some non-comparative studies 48,50,166 were also included in the analyses.…”

Section: Statement Of Principal Findingsmentioning

confidence: 99%

“…This meta-analysis also reported the absence of any significant side effects with FS. Leubke et al 48 and van den Bos et al 166 reported that EVLA and RFA were more effective than either surgery or FS. Murad et al 50 reported that surgery was more effective than both LS and endovenous interventions for preventing recurrence.…”

Section: Statement Of Principal Findingsmentioning

confidence: 99%

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Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Carroll

Hummel²,

Leaviss³

et al. 2013

Health Technology Assessment

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Comparable Effectiveness of Endovenous Laser Ablation and High Ligation With Stripping of the Great Saphenous Vein

Rass

Frings²,

Glowacki³

et al. 2012

Arch Dermatol

126

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Objective: To compare the clinical efficacy and safety of endovenous laser treatment (EVLT) with high ligation and stripping (HLS) as standard treatment for great saphenous vein (GSV) insufficiency. Design: Two-center randomized controlled trial with 2-year follow-up. Setting: Interventions were performed on ambulatory and hospitalized patients at 2 vein centers, a university dermatology department (EVLT-treated group), and a specialized vein clinic (HLS-treated group). Patients: Random sample of 400 patients with GSV insufficiency. Interventions: Patients were assigned (1:1) to EVLT or HLS of the GSV from September 2004 through March 2007; 185 and 161 patients (limbs), respectively, were treated per protocol. Main Outcome Measures: Clinically recurrent varicose veins after surgery (REVAS classification, primary study objective), duplex-detected saphenofemoral recurrence, clinical venous severity scoring (Homburg Varicose Vein Severity Score), hemodynamics (venous refilling time), quality of life (Chronic Venous Insufficiency Questionnaire 2), adverse effects, and visual analog scalebased evaluations of patients' satisfaction. Results: Clinically recurrent varicose veins after surgery were similarly observed in both groups: 16.2% (EVLTtreated group) vs 23.1% (HLS-treated group); P=.15. Duplex-detected saphenofemoral refluxes occurred significantly more frequently after EVLT (17.8% vs 1.3%; PϽ.001). Both treatments equally improved medical condition (Homburg Varicose Vein Severity Score) and diseaserelated quality of life. Endovenous laser treatment caused more adverse effects (phlebitic reaction, tightness, dyspigmentation) but revealed advantages concerning hemodynamics, recovery, and cosmetic outcome. Conclusions: Both EVLT and HLS are comparably safe and effective procedures to treat GSV incompetence. The significantly higher rate and the course of duplexdetected saphenofemoral recurrences after EVLT remain a matter of further investigations.

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Endovenous therapies of lower extremity varicosities: A meta-analysis

Abstract: In the absence of large, comparative randomized clinical trials, the minimally invasive techniques appear to be at least as effective as surgery in the treatment of lower extremity varicose veins.

Cited by 459 publications

References 36 publications

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Resultados de médio e longo prazo do tratamento endovenoso de varizes com laser de diodo em 1940 nm: análise crítica e considerações técnicas

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Comparable Effectiveness of Endovenous Laser Ablation and High Ligation With Stripping of the Great Saphenous Vein

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