Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation

Groenendael, Laura van; Vliet, J. Adam van der; Flinkenflögel, Lizel; Roovers, Elisabeth A.; Sterkenburg, Steven M.M. van; Reijnen, Michel M.P.J.

doi:10.1016/j.jvs.2009.06.057

Cited by 46 publications

(24 citation statements)

References 33 publications

(34 reference statements)

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“…About 20% of varicose surgeries are attributed to recurrences [49-53]. Differences in the initial treatment, the method of measuring recurrences and duration of follow-up make a comparison of recurrence rates difficult [56]. After surgical treatment of varicose veins and a follow-up period of three to eleven years, recurrence rates of 26-62% have been reported [57,58].…”

Section: Methodsmentioning

confidence: 99%

Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Kuhlmann

Prenzler

Hacker³

et al. 2013

Health Econ Rev

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ObjectivesIn contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany.MethodsTo assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic).ResultsIn the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters.ConclusionsResults of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance.

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Section: Methodsmentioning

confidence: 99%

Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Kuhlmann

Prenzler

Hacker³

et al. 2013

Health Econ Rev

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“…However, it is interesting to note that this last aspect does not have a negative effect on patient satisfaction with treatment [14,15,36]. Despite lower complication rates after EVLA than with open surgery in the treatment of recurrent saphenofemoral incompetence, there was no difference in the postoperative patient satisfaction in the previously mentioned study [34].…”

Section: Ultrasound-guided Foam Sclerotherapy (Ugfs)mentioning

confidence: 72%

“…1). A large-scale retrospective analysis from the Netherlands found that revision surgery and EVTA are used in a ratio of about 70:30 [34]. Redo groin surgery seems to be particularly suitable for large-diameter varicose openings e. g. with a residual stump (▶Fig.…”

Section: Inguinal Revision Surgerymentioning

confidence: 99%

Therapie des inguinalen Crossenrezidivs: Ist die offene Re-Crossektomie noch zeitgemäß?

Gerontopoulou

Rass²

2019

Phlebologie

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Zusammenfassung Einleitung Die Rezidivvarikose ist trotz der Entwicklung neuer Verfahren und Operationsstrategien ein relevantes medizinisches Problem. Zur Therapie inguinaler Crossenrezidive (ICR) steht die offene Re-Crossektomie zur Verfügung, die derzeit gegenüber weniger invasiven Verfahren in den Hintergrund tritt. Methoden Diese Übersichtsarbeit basiert auf aktuell verfügbaren Leitlinien und einer Literaturrecherche bei PubMed zur Frage des Einsatzes und der Effektivität verschiedener Verfahren zur Therapie des ICR. Ergebnisse Inguinale Re-Crossektomie und Schaumsklerosierung sind uneingeschränkt anwendbar. Die Operation, sofern mit Barrieretechnik kombiniert, scheint langfristig effektiver als die Verödung und ist mit einer hohen Patientenzufriedenheit verbunden. Endovenös thermische Ablationsverfahren können für individuelle Fälle mit geeignetem anatomischem Befund eingesetzt werden. Vergleichende Studien fehlen. Schlussfolgerung Die offene Re-Crossektomie ist zeitgemäß. Ob der Vorteil der potentiell höheren Effektivität bei der Operation stärker wiegt als die geringere Invasivität der Schaumsklerosierung verbunden mit häufigeren Therapiesitzungen müsste mittels randomisierter kontrollierter Studien geklärt werden.

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“…Laser has been used for treating saphenous vein recurrence, apparently mostly for ablation of re-canalized or remaining saphenous veins (25). Two retrospective case series from the Netherlands showed that surgery was still used for the majority of saphenous vein recurrences (30,31). The groups and treatments were obviously selected and the results therefore not comparable.…”

Section: Results From Redo Interventionsmentioning

confidence: 99%

Great uncertainty regarding treatment of varicose vein recurrence

Nelzén¹

2014

Phlebologie

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SummaryIntroduction: Although varicose vein recurrence is common and 10–30 % of all varicose vein surgery is done for recurrence of some sort, there are very few studies that can guide us to the best re-treatment option. With the introduction of minimal invasive endovenous treatments there is a variety of possible options besides traditional open surgical techniques.Method: The Scandinavian Venous Forum held a symposium at the GSP meeting in Lü-beck 2012 and this review article is based on data from the presentations at that symposium. Further data has been added regarding new knowledge that was not available a year ago, from PubMed search and article references.Results: The most common reasons for recurrence are discussed and also the discrepancy between neovascularization (NV) and recurrence due to technical failures. It is likely that NV is the most commonly duplex detected type of recurrence following open groin surgery, less common early after endovascular techniques. However, technical or tactical failures are the most common reasons for redo surgery because of symptomatic recurrence. NV seldom leads to symptomatic recurrences and thus a need for re- treatment. There is a risk that the stumps left following endovenous treatments will become a source for symptomatic recurrence after 5–10 years and indications of that have been reported in the few available 5 year RCT-reports following laser treatments. Treatment of recurrence due to stumps in the groin can be done safely within a reasonable operating time through a medial approach and the stump itself can generally not be treated with any of the endovenous alternative methods. Foam treatment can be used for most other recurrent veins but the durability is unknown. Endovascular thermal ablation can only be used for reopened or remaining saphenous veins and accessory saphenous veins while tributaries have to be treated by stab excisions or foam.Conclusion: Long term reports of results of redo surgery are limited but suggest reasonably good results from open surgical intervention and are non-existent for the endovenous techniques. So far groin recurrence seems best treated surgically by an indirect approach, preferably medial. More studies are needed to find the best treatment regime for varicose vein recurrence in general and hybrid procedures might be the way forward by combinations of different techniques.

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Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation

Abstract: EVLA is feasible in patients with recurrent varicose veins of the GSV. Complication rates are lower and socioeconomic outcome is better compared to surgical reintervention.

Cited by 46 publications

References 33 publications

Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

Therapie des inguinalen Crossenrezidivs: Ist die offene Re-Crossektomie noch zeitgemäß?

Great uncertainty regarding treatment of varicose vein recurrence

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