Sage Journals: Discover world-class research

Abstract

Background

In recent years, endovenous intervention has emerged as a minimally invasive alternative to open venous surgery. However, endovenous intervention does not formally disconnect the deep and superficial venous systems and it is hypothesized that recurrence may be greater in the absence of high venous ligation. This study aims to compare the efficacy of a hybrid endovenous approach with adjuvant high venous ligation and standard operative intervention in the management of great saphenous incompetence.

Methods

In March 2018, Medline and Embase were systematically searched for relevant randomized controlled trials. All randomized controlled trials comparing a hybrid approach with standard operative intervention were included. Studies were required to include at least one pre-defined outcome. Data were extracted and assessed by two independent reviewers. Pooled risk ratios were calculated using a random effects model. Additional subgroup analyses were performed.

Results

Eight randomized controlled trials including 1244 patients were analysed. Pooled standardized data revealed no difference in overall recurrence (pooled RR = 1.00 [95% CI = 0.57, 1.77]), major operative morbidity (RR = 0.43 [95% CI = 0.06, 2.89]), or re-interventions (RR = 0.94 [95% CI = 0.12, 7.24]) for the hybrid group compared with standard operative intervention alone. Subgroup analysis revealed comparable short-, medium- and long-term recurrence rates between both cohorts. Furthermore, no difference in recurrence was identified when the hybrid approach was compared to open surgery alone (RR = 1.01 [95% CI = 0.63, 1.61]) or endovenous monotherapy (RR = 0.67 [95% CI = 0.04, 12.24]).

Conclusion

The use of a hybrid approach in the management of great saphenous incompetence appears to offer no recurrence, re-intervention or morbidity benefit when compared to standard operative intervention.

Keywords

Varicose veins surgery hybrid approach endovenous intervention

Get full access to this article

View all access options for this article.

References

Evans

Lee

Fowkes

et al . Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999; 53: 149–153.

Kurz

Lamping

Kahn

et al . Do varicose veins affect quality of life? Results of an international population-based study. J Vasc Surg 2001; 34: 641–648

Lynch

Clarke

Fulton

GJ.

Surgical management of great saphenous vein varicose veins: a meta-analysis.

Vascular 2015; 23: 285–296.

Keller

A new method of extirpating the internal saphenous and other similar veins in varicose conditions. A preliminary report. NY Med J 1905; 2: 3858.

Subramonia

Lees

Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins.

Br J Surg 2010; 97: 328–336.

Rasmussen

Lawaetz

Bjoern

et al . Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 2011; 98: 1079–1087.

Nesbitt

Bedenis

Bhattacharya

et al . Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev 2014; 7: CD005624.

Carroll

Hummel

Leaviss

et al . Systematic review, network meta-analysis and exploratory cost-effectiveness model of randomized trials of minimally invasive techniques versus surgery for varicose veins. Br J Surg 2014; 101: 1040–1052.

Kheirelseid

EAH

Crowe

Sehgal

et al . Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord 2018; 6: 256–270.

10.

Bountouroglou

Azzam

Kakkos

et al . 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 Surg 2006; 31: 93–100.

11.

Kalodiki

Lattimer

Azzam

et al . Long-term results of a randomized controlled trial on ultrasound-guided foam sclerotherapy combined with saphenofemoral ligation vs standard surgery for varicose veins. J Vasc Surg 2012; 55: 451–457.

12.

Abela

Liamis

Prionidis

et al . 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 Surg 2008; 36: 485–490.

13.

Disselhoff

der Kinderen

Kelder

et al . Randomized clinical trial comparing endovenous laser ablation of the great saphenous vein with and without ligation of the sapheno-femoral junction: 2-year results. Eur J Vasc Endovasc Surg 2008; 36: 713–718.

14.

Disselhoff

der Kinderen

Kelder

et al . Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg 2011; 41: 685–690.

15.

Kalteis

Adelsgruber

Messie-Werndl

et al . Five-year results of a randomized controlled trial comparing high ligation combined with endovenous laser ablation and stripping of the great saphenous vein. Dermatol Surg 2015; 41: 579–586.

16.

Kalteis

Berger

Messie-Werndl

et al . High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study. J Vasc Surg 2008; 47: 822–829.

17.

Liu

Jia

Guo

et al . Ultrasound-guided foam sclerotherapy of the great saphenous vein with sapheno-femoral ligation compared to standard stripping: a prospective clinical study. Int Angiol 2011; 30: 321–326.

18.

Yang

Wang

et al . Randomized clinical trial of endovenous microwave ablation combined with high ligation versus conventional surgery for varicose veins. Eur J Vasc Endovasc Surg 2013; 46: 473–479.

19.

Flessenkämper

Hartmann

et al . Endovenous laser ablation with and without high ligation compared to high ligation and stripping for treatment of great saphenous varicose veins: results of a multicentre randomised controlled trial with up to 6 years follow-up. Phlebology 2016; 31: 23–33.

20.

Flessenkämper

Hartmann

Stenger

et al . Endovenous laser ablation with and without high ligation compared with high ligation and stripping in the treatment of great saphenous varicose veins: initial results of a multicentre randomized controlled trial. Phlebology 2013; 28: 16–23.

21.

Yin

Wang

et al . Prospective randomized study of ultrasound-guided foam sclerotherapy combined with great saphenous vein high ligation in the treatment of severe lower extremity varicosis. Ann Vasc Surg 2017; 39: 256–263.

22.

Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

23.

DerSimonian

Laird

NM.

Evaluating the effect of coaching on sat scores – a meta-analysis.

Harv Educ Rev 1983; 53: 1–15.

24.

Higgins

Altman

Gotzsche

et al . The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928.

25.

Ran

Shi

Qiao

et al . Comparison of foam sclerotherapy alone or combined with stripping of the great saphenous vein for treating varicose veins. Dermatol Surg 2017; 43: 541–547.

26.

Islamoglu

An alternative treatment for varicose veins: ligation plus foam sclerotherapy.

Dermatol Surg 2011; 37: 470–479.

27.

Belcaro

Nicolaides

Ricci

et al . Endovascular sclerotherapy, surgery, and surgery plus sclerotherapy in superficial venous incompetence: a randomized, 10-year follow-up trial – final results. Angiology 2000; 51: 529–534.

28.

Rutgers

Kitslaar

PJ.

Randomized trial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein.

Am J Surg 1994; 168: 311–315.

29.

Yang

et al . Prospective Comparison of Effect of Ligation and Foam Sclerotherapy with Foam Sclerotherapy Alone for Varicose Veins. Ann Vasc Surg 2018; 49: 75--79.

30.

Brethauer

Murray

Hatter

et al . Treatment of varicose veins: proximal saphenofemoral ligation comparing adjunctive varicose phlebectomy with sclerotherapy at a military medical center. Vasc Surg 2001; 35: 51–58.

31.

Chandler

Pichot

Sessa

et al . Defining the role of extended saphenofemoral junction ligation: a prospective comparative study. J Vasc Surg 2000; 32: 941–953.

32.

Belcaro

Cesarone

Di Renzo

et al . Foam-sclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 10-year, prospective, randomized, controlled, trial (VEDICO trial). Angiology 2003; 54: 307–315.

33.

Gradman

WS.

Adjunctive proximal vein ligation with endovenous obliteration of great saphenous vein reflux: does it have clinical value?

Ann Vasc Surg 2007; 21: 155–158.

34.

van Rij

Jiang

Solomon

et al . Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. J Vasc Surg 2003; 38: 935–943.

35.

Glass

GM.

Neovascularization in recurrence of the varicose great saphenous vein following transaction.

Phlebology 1987; 2: 81–91.

36.

Egan

Donnelly

Bresnihan

et al . Neovascularization: an “innocent bystander” in recurrent varicose veins. J Vasc Surg 2006; 44: 1279–1284.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.39 MB