Surgery versus sclerotherapy for the treatment of varicose veins

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

“…38 This includes techniques such as VNUS Closure, ® VNUS ClosureFast ® (VNUS Medical Technologies, Inc., San Jose, CA) 54 and Olympus RFiTT ® (Olympus Surgical Technologies Europe, Hamburg, Germany). 55 Patients with either GSV or SSV incompetence might receive this intervention.…”

“…Fourteen trials 53,55,84,87,88,[95][96][97][98][99][100][101][102][103] evaluated EVLA, but Rasmussen et al 95 was a multiarm trial with more than one comparator. Eight compared the intervention with a form of conventional surgery ( Finally, Aremu et al 124 compared TIPP with conventional surgery and Chetter et al 39 compared TIPP with standard multistab incision phlebectomy (MSIP) ( Table 9).…”

“…97,100 These studies, as reported, therefore had a high risk of selection bias. Thirteen studies either clearly failed to conduct an intention-to-treat analysis or left it unclear whether or not they had done so, and so were categorised as not clearly conducting such an analysis; 42,53,55,77,79,80,88,91,102,114,117,122,124 six of these also failed to report adequate methods of randomisation and allocation concealment, 77,79,80,114,117,122 all but one of which were abstracts only. 114 Two further key criteria were assessed that had the greatest potential to confound the results of this report: the non-comparability of groups at baseline and non-identical care programmes post intervention.…”

“…Twelve studies reported in full papers were at risk of two or more of these forms of bias, 55 The majority of the trials used in the network meta-analyses (e.g. those reporting technical recurrence data for EVLA vs. stripping or EVLA vs. RFA, etc.)…”

“…Twelve trials 42,44,55,81,88,89,90,95,97,98,119,112 reported data on the failure of the initial procedure (i.e. the intervention failed to strip the vein successfully or the vein was not occluded or obliterated, or open segments remained) within the first few days post operation up to 1 month (see Table 11).…”