Randomized clinical trial of the effect of adding subfascial endoscopic perforator surgery to standard great saphenous vein stripping

Kianifard, B.; Holdstock, Judy M; Allen, Coburn H.; Smith, Claire; Price, B. A.; Whiteley, Mark S

doi:10.1002/bjs.5945

Cited by 55 publications

(36 citation statements)

References 24 publications

(32 reference statements)

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“…23,[342][343][344][346][347][348]350 Therapy can be repeated with ease, risk of complications is minimal, and early to midterm results in case series are equivalent to or better than those reported after conventional perforating vein interruptions. [356][357][358] The risks of open procedures, which specifically include infection, difficulty in healing of incisions required for treatment, increased local trauma, and need for general anesthesia, set open operations apart from these less invasive percutaneous methods.…”

Section: Evidence -C]mentioning

confidence: 49%

“…[339][340][341][342][343][344][345][346][347][348][349][350][351][352] The Dutch RCT comparing subfascial endoscopic perforator vein surgery (SEPS) with or without superficial reflux ablation to medical treatment in patients with venous ulcers found no difference in healing rate or recurrence in the two treatment groups. 317 However, patients with recurrent ulceration or medially located ulcers in the surgical group had a longer ulcer-free period than did those treated in the conservative group (P ¼ .02).…”

Section: Guideline 61 Superficial Venous Reflux and Active Venous Lementioning

confidence: 99%

See 1 more Smart Citation

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

O’Donnell¹,

Passman²,

Marston³

et al. 2014

Journal of Vascular Surgery

575

450

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Section: Evidence -C]mentioning

confidence: 49%

Section: Guideline 61 Superficial Venous Reflux and Active Venous Lementioning

confidence: 99%

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

O’Donnell¹,

Passman²,

Marston³

et al. 2014

Journal of Vascular Surgery

575

450

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“…Current data do not support adding perforator ablation to ablation of the superficial system in patients with simple varicose veins, 361,362 and the Committee recommends against treatment of perforators in patients with CEAP class C 2 disease (GRADE 1B). In patients with advanced CVI, current data provide moderate evidence that large (Ն3.5 mm), high-volume, incompetent "pathologic" perforators (reflux Ն500 ms), located in the affected area of the limb with outward flow on duplex scanning in patients with class C 5 or C 6 disease, can be treated by experienced interventionists, unless the deep veins are obstructed (GRADE 2B).…”

Section: Results Of Perforator Ablationmentioning

confidence: 96%

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Gloviczki

Comerota²,

Dalsing

et al. 2011

Journal of Vascular Surgery

1,266

952

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The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C(2); GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration ≥500 ms, vein diameter ≥3.5 mm) located underneath healed or active ulcers (CEAP class C(5)-C(6); GRADE 2B). We suggest treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs, or transcatheter sclerotherapy, used alone or together (GRADE 2B).

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“…Recommendations from the American Venous Forum and Society of Vascular Surgery (7) limit indications of perforator ablation to those in close proximity to venous stasis ulcers in patients with advanced (C5/C6) disease. Studies examining perforator vein interruption at earlier disease stages were based on highly invasive surgical treatments that overshadowed any improvement in patient quality of life (16,17). The minimally invasive nature of endothermal modalities overcomes the high morbidity of traditional surgical techniques such as subendoscopic perforator surgery (18,19), and establishing the technical feasibility and safety of perforating vein EVLA sets the stage for larger-scale studies aimed at revising treatment indications.…”

Section: Discussionmentioning

confidence: 99%

Endovenous Laser Ablation of Perforating Veins: Feasibility, Safety, and Occlusion Rate Using a 1,470-nm Laser and Bare-Tip Fiber

Chehab

Dixit

Antypas

et al. 2015

Journal of Vascular and Interventional Radiology

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Randomized clinical trial of the effect of adding subfascial endoscopic perforator surgery to standard great saphenous vein stripping

Abstract: ISRCTN18288048 (http://www.controlled-trials.com).

Cited by 55 publications

References 24 publications

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Endovenous Laser Ablation of Perforating Veins: Feasibility, Safety, and Occlusion Rate Using a 1,470-nm Laser and Bare-Tip Fiber

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