Varicose Veins: A Comparison of Surgery and Injection/Compression Sclerotherapy

Chant, A.D.B.; Jones, Helen M.F.; Weddell, J. M.

doi:10.1016/s0140-6736(72)92607-4

Cited by 74 publications

(22 citation statements)

References 10 publications

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“…However, when the three studies with Յ2 years follow-up were excluded, the decreased risk of recurrence with surgery became statistically significant (RR, 0.45; 95% CI, 0.22-0.93; I 2 ϭ 93%). Moreover, when older studies (Ͻ1980) were excluded in sensitivity analysis, 26,31,33,41 the results remained statistically significant (RR, 0.38; 95% CI, 0.16-0.90; I 2 ϭ 94%). No significant associations were found with other outcomes such as the risk of PE in four studies (RR 0.30; 95% CI, 0.06-1.46; I 2 ϭ 0%) and the proportion of patients satisfied (86% vs 82%; P ϭ .71); however, the small number of events makes these estimates imprecise.…”

Section: Sclerotherapy Studiesmentioning

confidence: 91%

“…RCTs and observational studies published in the 1960s and 1970s showed that sclerotherapy was as effective as surgery, particularly in patients without incompetent perforating veins. 56 In addition, patients in these studies preferred sclerotherapy, 33 which gave better initial results 26 and was less likely to require additional treatment. 31 However, studies with longer follow-up periods suggested that the initial benefits of sclerotherapy declined over time.…”

Section: Sclerotherapy Studiesmentioning

confidence: 96%

“…Allocation concealment was conducted in five of the RCTs (three by sealed envelope and two by central randomization), 32,33,52,55,56 only two RCTs used blind outcome assessors, 18,40 and one blinded patients. 37 In the observational studies, it was difficult to ascertain whether study arms were comparable at baseline.…”

Section: Study Identificationmentioning

confidence: 99%

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A systematic review and meta-analysis of the treatments of varicose veins

Murad

Coto-Yglesias

Zumaeta-Garcia

et al. 2011

Journal of Vascular Surgery

130

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Section: Sclerotherapy Studiesmentioning

confidence: 91%

Section: Sclerotherapy Studiesmentioning

confidence: 96%

See 1 more Smart Citation

A systematic review and meta-analysis of the treatments of varicose veins

Murad

Coto-Yglesias

Zumaeta-Garcia

et al. 2011

Journal of Vascular Surgery

130

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“…Those with untreated incompetent saphenous veins have the highest rate of recurrence. 295, 328 Kern et al 329 reported results of liquid sclerotherapy of telangiectasia and reticular veins in 96 patients. Those who wore elastic stockings for 3 weeks after treatment had an early success rate of 76%.…”

Section: Sclerotherapymentioning

confidence: 99%

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

1,273

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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“…First, in some series (e.g. Fegan, 1967) the results have been analysed by a single observer; secondly (notably in the series of Chant et al, 1972) the results have been expressed by measuring parameters which are themselves beyond dispute, such as whether the patient did or did not receive further treatment.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the results of surgery for varicose veins

McAdam

Horrocks

Dombal

1976

Journal of British Surgery

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Fifty-six patients undergoing primary surgery for unilateral varicose veins by a standardized Trendelenburg procedure were reviewed postoperatively by a panel of three observers. Agreement between the observers was high in assessing symptomatic response (up to 98%), but only moderate in evaluation of any visual changes in affected legs (60%). Moreover, intr-observer agreement comparing symptomatic response and visual impression was very low (30-4%). It is suggested that inter-series comparisons should be made solely upon the response of specific symptoms to treatment.

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Varicose Veins: A Comparison of Surgery and Injection/Compression Sclerotherapy

Cited by 74 publications

References 10 publications

A systematic review and meta-analysis of the treatments of varicose veins

A systematic review and meta-analysis of the treatments of varicose veins

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

Assessment of the results of surgery for varicose veins

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