There is insufficient evidence to inform guidelines on the optimal compression strategy following ablation for varicose veins. This study aimed to identify the practice of key opinion leaders performing randomised clinical trials involving endovenous ablation.
Method
A systematic review of MEDLINE/EMBASE/CENTRAL was performed identifying the compression strategies used in randomised clinical trials where at least one comparator arm underwent endovenous ablation.
Results
Thirty-four randomised clinical trials were identified. At least 14 different compression products were used, with at least 6 different pressures in 7 different regimes with durations from 2 to 84 days. There was no evidence of any convergence of practice over time.
Conclusions
A lack of evidence as to the optimal strategy for compression has resulted in a marked variation in clinical practice. There is no suggestion that this variation is becoming less over time indicating that experience is not helping to form a consensus and, therefore, further research is required.
CarpentierPHMaricqHRBiroC. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: A population-based study in France. J Vasc Surg2004; 40: 650–659.
2.
EvansCJAllanPLLeeAJ. Prevalence of venous reflux in the general population on duplex scanning: The Edinburgh vein study. J Vasc Surg1998; 28: 767–776.
3.
MaurinsUHoffmannBHLoschC. Distribution and prevalence of reflux in the superficial and deep venous system in the general population–results from the Bonn Vein Study, Germany. J Vasc Surg2008; 48: 680–687.
4.
Beebe-DimmerJLPfeiferJREngleJS. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol2005; 15: 175–184.
5.
DarvallKABateGRAdamDJ. Generic health-related quality of life is significantly worse in varicose vein patients with lower limb symptoms independent of CEAP clinical grade. Eur J Vasc Endovasc Surg2012; 44: 341–344.
6.
The National Institute for Health and Care Excellence (NICE). Varicose veins in the legs: the diagnosis and management of varicose veins (GC168). Clinical Guidelines 2013.
7.
El-Sheikha J, Nandhra S, Carradice D, et al. Compression regimes after endovenous ablation for superficial venous insufficiency - A survey of members of the Vascular Society of Great Britain and Ireland. Phlebology 2016; 31: 16–22.
8.
Hamel-DesnosCMGuiasBJDesnosPR. Foam sclerotherapy of the saphenous veins: Randomised controlled trial with or without compression. Eur J Vasc Endovasc Surg2010; 39: 500–507.
9.
LabropoulosNLeonMVolteasN. Acute and long-term effect of elastic stockings in patients with varicose veins. Int Angiol1994; 13: 119–123.
10.
MayberryJCMonetaGLTaylorLMJr. Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. Surgery1991; 109: 575–581.
11.
El-SheikhaJCarradiceDNandhraS. Systematic review of compression following treatment for varicose veins. Br J Surg2015; 102: 719–725.
12.
RastelDPerrinMGuidicelliH. Compressive therapy after varicose vein surgery: Results of a French national inquiry. J Malad Vasc2004; 29: 27–34.
13.
Tripey V, Monsallier JM, Morello R, Hamel-Desnos C. French sclerotherapy and compression: Practice patterns. Phlebology 2015; 30: 632–640.
14.
LiberatiAAltmanDGTetzlaffJ. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ2009; 339: b2700–b2700.
15.
MarsdenGPerryMKelleyK. Guideline Development G. Diagnosis and management of varicose veins in the legs: Summary of NICE guidance. BMJ2013; 347: f4279–f4279.
16.
MaurinsURabeEPannierF. Does laser power influence the results of endovenous laser ablation (EVLA) of incompetent saphenous veins with the 1 470-nm diode laser? A prospective randomized study comparing 15 and 25 W. Int Angiol2009; 28: 32–37.
17.
CarradiceDMekakoAIMazariFA. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg2011; 98: 501–510.
18.
DarwoodRJTheivacumarNDellagrammaticasD. Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg2008; 95: 294–301.
19.
DisselhoffBCder KinderenDJKelderJC. Randomized clinical trial comparing endovenous laser with cryostripping for great saphenous varicose veins. Br J Surg2008; 95: 1232–1238.
20.
de MedeirosCALuccasGC. Comparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg2005; 31: 1685–1694. discussion 1694.
21.
PronkPGauwSAMooijMC. Randomised controlled trial comparing sapheno-femoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anaesthesia: One year results. Eur J Vasc Endovasc Surg2010; 40: 649–656.
22.
RassKFringsNGlowackiP. Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: Two-year results of a randomized clinical trial (RELACS study). Arch Dermatol2012; 148: 49–58.
23.
RasmussenLHBjoernLLawaetzM. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: Short-term results. J Vasc Surg2007; 46: 308–315.
24.
SamuelNCarradiceDWallaceT. Randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. Ann Surg2013; 257: 419–426.
25.
Helmy ElKaffasKElKashefOElBazW. Great saphenous vein radiofrequency ablation versus standard stripping in the management of primary varicose veins - a randomized clinical trial. Angiology2011; 62: 49–54.
26.
RautioTOhinmaaAPeralaJ. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: A randomized controlled trial with comparison of the costs. J Vasc Surg2002; 35: 958–965.
27.
StötterLSchaafIBockelbrinkA. Comparative outcomes of radiofrequency endoluminal ablation, invagination stripping, and cryostripping in the treatment of great saphenous vein insufficiency. Phlebology2006; 21: 60–64.
28.
SubramoniaSLeesT. Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg2010; 97: 328–336.
29.
AlmeidaJIKaufmanJGockeritzO. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: A multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol2009; 20: 752–759.
30.
GaleSSLeeJNWalshME. A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg2010; 52: 645–650.
31.
GoodeSDChowdhuryACrockettM. Laser and radiofrequency ablation study (LARA study): A randomised study comparing radiofrequency ablation and endovenous laser ablation (810 nm). Eur J Vasc Endovasc Surg2010; 40: 246–253.
32.
NordonIMHinchliffeRJBrarR. A prospective double-blind randomized controlled trial of radiofrequency versus laser treatment of the great saphenous vein in patients with varicose veins. Ann Surg2011; 254: 876–881.
33.
ShepherdACGohelMSBrownLC. Randomized clinical trial of VNUS ClosureFAST radiofrequency ablation versus laser for varicose veins. Br J Surg2010; 97: 810–818.
34.
CarradiceDMekakoAIHatfieldJ. Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Br J Surg2009; 96: 369–375.
35.
DoganciSDemirkilicU. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: A prospective randomised clinical trial. Eur J Vasc Endovasc Surg2010; 40: 254–259.
36.
SamuelNWallaceTCarradiceD. Comparison of 12-w versus 14-w endovenous laser ablation in the treatment of great saphenous varicose veins: 5-year outcomes from a randomized controlled trial. Vasc Endovasc Surg2013; 47: 346–352.
37.
TheivacumarNSDellagrammaticasDMavorAI. Endovenous laser ablation: Does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg2008; 48: 173–178.
38.
VuylstekeMEThomisSMahieuP. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: A randomised clinical trial. Eur J Vasc Endovasc Surg2012; 44: 587–592.
39.
BountouroglouDGAzzamMKakkosSK. Ultrasound-guided foam sclerotherapy combined with sapheno-femoral ligation compared to surgical treatment of varicose veins: Early results of a randomised controlled trial. Eur J Vasc Endovasc Surg2006; 31: 93–100.
40.
FigueiredoMAraujoSBarrosNJr. Results of surgical treatment compared with ultrasound-guided foam sclerotherapy in patients with varicose veins: A prospective randomised study. Eur J Vasc Endovasc Surg2009; 38: 758–763.
41.
ShadidNCeulenRNelemansP. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg2012; 99: 1062–1070.
42.
WrightDGobinJPBradburyAW. Varisolve® polidocanol microfoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology2006; 21: 180–190.
43.
van den BosRRMalskatWSde MaeseneerMG. Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous varicose veins. Br J Surg2014; 101: 1077–1083.
44.
LattimerCRAzzamMKalodikiE. Cost and effectiveness of laser with phlebectomies compared with foam sclerotherapy in superficial venous insufficiency. Early results of a randomised controlled trial. Eur J Vasc Endovasc Surg2012; 43: 594–600.
45.
BiemansAAKockaertMAkkersdijkGP. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg2013; 58: 727–734 e721.
46.
BrittendenJCottonSCEldersA. A randomized trial comparing treatments for varicose veins. N Engl J Med2014; 371: 1218–1227.
47.
RasmussenLHLawaetzMBjoernL. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg2011; 98: 1079–1087.
48.
AbelaRLiamisAPrionidisI. Reverse foam sclerotherapy of the great saphenous vein with sapheno-femoral ligation compared to standard and invagination stripping: A prospective clinical series. Eur J Vasc Endovasc Surg2008; 36: 485–490.
49.
RoopramADLindMYvan BrusselJP. Endovenous laser ablation versus conventional surgery in the treatment of small saphenous vein incompetence. J Vasc Surg2013; 1: 357–363.
50.
TheivacumarNSDellagrammaticasDMavorAI. Endovenous laser ablation: Does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg2008; 48: 173–178.
51.
van den BosRArendsLKockaertM. Endovenous therapies of lower extremity varicosities: A meta-analysis. J Vasc Surg2009; 49: 230–239.
52.
MostiG. Post-treatment compression: Duration and techniques. Phlebology2013; 28: 21–24.
53.
LugliMCogoAGuerzoniS. Effects of eccentric compression by a crossed-tape technique after endovenous laser ablation of the great saphenous vein: A randomized study. Phlebology2009; 24: 151–156.
54.
KievJNoyesLDRiceJC. Patient compliance with fitted compression hosiery monitored by photoplethysmography. Arch Phys Med Rehab1990; 71: 376–379.
55.
DaleJJGibsonB. Information will enhance compliance. Informing clients about compression hosiery. Prof Nurse1992; 7: 755–756, 758–760.
56.
NelsonEABell-SyerSE. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev2012; 8: CD002303–CD002303.
57.
FranksPJMoffattCJConnollyM. Factors associated with healing leg ulceration with high compression. Age Ageing1995; 24: 407–410.
58.
PartschHClarkMBassezS. Measurement of lower leg compression in vivo: Recommendations for the performance of measurements of interface pressure and stiffness: Consensus statement. Dermatol Surg2006; 32: 224–232. discussion 233.
