Effectiveness of treatments of varicose veins: systematic review and evidence synthesis
File(s)
Accepted version
Author(s)
Bootun, R
Epstein, D
onida
Ortega-Ortega, M
davies, A
Type
Conference Paper
Abstract
Background
Novel methods of varicose vein treatment have been introduced in the past few years with the expectation that they might be more advantageous than conventional procedures. A systematic review and network meta-analysis was conducted comparing the effectiveness of current treatment (conservative care, surgery, ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA)) to emerging technologies (mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE)).
Methods
A systematic review of the literature was undertaken with evidence from randomised controlled trials (RCTs) collected for current technologies. However, because of a paucity of randomised studies, evidence for the newer endovenous ablation procedures was obtained from non-randomised studies in a secondary analysis. Outcomes measured were re-intervention on the truncal vein and re-treatment for residual varicosities.
Results
Thirty-three RCTs and a further ten non-randomised studies evaluating MOCA or CAE were analysed. Thirteen RCTs and three non-randomised studies reported on re-interventions and re-treatments. The rate of re-interventions was found to be similar between EVLA, RFA and surgery. The rate of re-intervention after MOCA appears lower than UGFS (incidence rate ratio MOCA v UGFS 0.395) and greater than surgery (incidence rate ratio MOCA v surgery 1.378).
Conclusion
This is the first systematic review that has conducted a meta-analysis of re-intervention and retreatment. The high attrition rate is the main risk of bias identified in the RCTs. Further, high quality studies comparing MOCA and CAE to other modalities are needed to establish truncal re-intervention rates and rate of re-treatment of residual varicosities.
Novel methods of varicose vein treatment have been introduced in the past few years with the expectation that they might be more advantageous than conventional procedures. A systematic review and network meta-analysis was conducted comparing the effectiveness of current treatment (conservative care, surgery, ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA)) to emerging technologies (mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE)).
Methods
A systematic review of the literature was undertaken with evidence from randomised controlled trials (RCTs) collected for current technologies. However, because of a paucity of randomised studies, evidence for the newer endovenous ablation procedures was obtained from non-randomised studies in a secondary analysis. Outcomes measured were re-intervention on the truncal vein and re-treatment for residual varicosities.
Results
Thirty-three RCTs and a further ten non-randomised studies evaluating MOCA or CAE were analysed. Thirteen RCTs and three non-randomised studies reported on re-interventions and re-treatments. The rate of re-interventions was found to be similar between EVLA, RFA and surgery. The rate of re-intervention after MOCA appears lower than UGFS (incidence rate ratio MOCA v UGFS 0.395) and greater than surgery (incidence rate ratio MOCA v surgery 1.378).
Conclusion
This is the first systematic review that has conducted a meta-analysis of re-intervention and retreatment. The high attrition rate is the main risk of bias identified in the RCTs. Further, high quality studies comparing MOCA and CAE to other modalities are needed to establish truncal re-intervention rates and rate of re-treatment of residual varicosities.
Date Issued
2017-04-06
Date Acceptance
2017-01-18
Citation
British Journal of Surgery, 2017, 104 (S3), pp.28-28
ISSN
1365-2168
Publisher
Wiley
Start Page
28
End Page
28
Journal / Book Title
British Journal of Surgery
Volume
104
Issue
S3
Copyright Statement
© 2017 The Authors. BJS © 2017 BJS Society Ltd. This is the accepted version of the following article: (2017), SARS abstracts. Br J Surg, 104: 7–57. doi:10.1002/bjs.10531, which has been published in final form at: https://dx.doi.org/10.1002/bjs.10531
Source
Society for Academic and Research Surgery
Subjects
Surgery
11 Medical And Health Sciences
Publication Status
Published
Start Date
2017-01-18
Finish Date
2017-01-19
Coverage Spatial
Dublin, Republic of Ireland