Foam-Sclerotherapy, Surgery, Sclerotherapy, and Combined Treatment for Varicose Veins: A 10-Year, Prospective, Randomized, Controlled, Trial (VEDICO Trial)

Abstract

The study compared, by a prospective, randomized method, 6 treatment options: A: Sclerotherapy; B: High-dose sclerotherapy; C: Multiple ligations; D: Stab avulsion; E: Foam-sclerotherapy; F: Surgery (ligation) followed by sclerotherapy. Results were analyzed 10 years after inclusion and initial treatment. Endpoints of the study were variations in ambulatory venous pressure (AVP), refilling time (RT), presence of duplex-reflux, and number of recurrent or new incompetent venous sites. The number of patients, limbs, and treated venous segments were comparable in the 6 treatment groups, also comparable for age and sex distribution. The occurrence of new varicose veins at 5 years varied from 34% for group F (surgery + sclero) and ligation (C) to 44% for the foam + sclero group (E) and 48% for group A (dose 1 sclero). At 10 years the occurrence of new veins varied from 37% in F to 56% in A. At inclusion AVP was comparable in the different groups. At 10 years the decrease in AVP and the increase in RT (indicating decrease in reflux), was generally comparable in the different groups. Also at 10 years the number of new points of major incompetence was comparable in all treatment groups. These results indicate that, when correctly performed, all treatments may be similarly effective. "Standard," low-dose sclerotherapy appears to be less effective than high-dose sclero and foam-sclerotherapy which may obtain, in selected subjects, results comparable to surgery.

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

“…[27][28][29][30][31][32] The second principal intervention used, conventional LS, is considered faster but less effective than surgical stripping. 33 The principal outcomes associated with treatment for varicose veins are symptom relief and symptom severity, recurrence of varicosities, as well as the occurrence of new varicosities in the same limb, and retreatment. Reported recurrence rates vary widely depending on the nature of the surgical technique performed and method of assessment.…”

“…Eleven citations represented relevant ongoing trials [64][65][66][67][68][69][70][71][72][73][74] and none of the available data were appropriate for analysis in one study. 75,76 Fifty-four citations, representing 34 different studies, therefore provided data for analysis (see the PRISMA flow chart, Figure 1). …”

Ecoescleroterapia com microespuma em varizes tronculares primárias

“…A avaliação pulmonar por cintilografia, após a perfusão venosa de 10 ml de microespuma, não detectou alteração alguma 19 . Em nosso trabalho, nós também não detectamos nenhuma complicação respiratória, embora a nossa amostra seja ainda pequena, com 47 perfusões de microespuma nos 25 membros tratados.…”

Fístula arteriovenosa após escleroterapia com espuma guiada por ultrassom: relato de caso

“…3 However, medium and long-term recanalization rates are still high. 4 This article describes a case in which an arteriovenous fistula was identified with ultrasonography in a recanalized segment of the great saphenous vein that had been treated using ultrasound guided foam sclerotherapy.…”

“…4 When used appropriately, this is a technique that has low rates of complications 15,16 and AVF is not a normal complication of the procedure. Cavezzi and Parsi 17 have provided a general panorama of the primary complications of USFS.…”