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Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis.
J Endovasc Ther. 2016 Feb; 23(1):199-211.JE

Abstract

PURPOSE

To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence.

METHODS

A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A random-effects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means.

RESULTS

The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%).

CONCLUSION

Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance.

Authors+Show Affiliations

Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands doekeboersma@gmail.com.Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.Department of Epidemiology and Statistics, St. Antonius Hospital, Nieuwegein, the Netherlands.Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26564912

Citation

Boersma, Doeke, et al. "Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis." Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists, vol. 23, no. 1, 2016, pp. 199-211.
Boersma D, Kornmann VN, van Eekeren RR, et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther. 2016;23(1):199-211.
Boersma, D., Kornmann, V. N., van Eekeren, R. R., Tromp, E., Ünlü, Ç., Reijnen, M. M., & de Vries, J. P. (2016). Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists, 23(1), 199-211. https://doi.org/10.1177/1526602815616375
Boersma D, et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther. 2016;23(1):199-211. PubMed PMID: 26564912.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. AU - Boersma,Doeke, AU - Kornmann,Verena N N, AU - van Eekeren,Ramon R J P, AU - Tromp,Ellen, AU - Ünlü,Çagdas, AU - Reijnen,Michel M J P, AU - de Vries,Jean-Paul P M, Y1 - 2015/11/12/ PY - 2015/11/14/entrez PY - 2015/11/14/pubmed PY - 2016/11/9/medline KW - endovenous laser ablation KW - foam sclerotherapy KW - incompetent vein KW - mechanochemical ablation KW - meta-analysis KW - pharmacomechanical ablation KW - radiofrequency ablation KW - reflux KW - small saphenous vein KW - varicose vein KW - venous insufficiency SP - 199 EP - 211 JF - Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists JO - J Endovasc Ther VL - 23 IS - 1 N2 - PURPOSE: To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. METHODS: A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A random-effects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means. RESULTS: The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). CONCLUSION: Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance. SN - 1545-1550 UR - https://www.unboundmedicine.com/medline/citation/26564912/Treatment_Modalities_for_Small_Saphenous_Vein_Insufficiency:_Systematic_Review_and_Meta_analysis_ DB - PRIME DP - Unbound Medicine ER -