Hamann SAS, Giang J, De Maeseneer MGR, Nijsten TEC, van den Bos RR, et al.
European journal of vascular and endovascular surgery : the official journal of the European So.... Date of publication 2017 Dec 1;volume 54(6):760-770.
1. Eur J Vasc Endovasc Surg. 2017 Dec;54(6):760-770. doi:
10.1016/j.ejvs.2017.08.034. Epub 2017 Oct 14.
Editor's Choice - Five Year Results of Great Saphenous Vein Treatment: A
Meta-analysis.
Hamann SAS(1), Giang J(2), De Maeseneer MGR(1), Nijsten TEC(1), van den Bos
RR(3).
Author information:
(1)Department of Dermatology, Erasmus Medical Centre, Erasmus University
Rotterdam, Rotterdam, The Netherlands.
(2)Erasmus University Rotterdam, Rotterdam, The Netherlands.
(3)Department of Dermatology, Erasmus Medical Centre, Erasmus University
Rotterdam, Rotterdam, The Netherlands. Electronic address:
r.vandenbos@erasmusmc.nl.
Comment in
Eur J Vasc Endovasc Surg. 2017 Dec;54(6):771. doi:
10.1016/j.ejvs.2017.09.009.
Eur J Vasc Endovasc Surg. 2018 May;55(5):742. doi:
10.1016/j.ejvs.2018.01.034.
OBJECTIVES: The most frequently used treatment options for great saphenous vein
incompetence are high ligation with stripping (HL+S), endovenous thermal
ablation (EVTA), mainly consisting of endovenous laser ablation (EVLA) or
radiofrequency ablation, and ultrasound guided foam sclerotherapy (UGFS). The
objective of this systematic review and meta-analysis was to compare the
long-term efficacy of these different treatment modalities.
METHODS: A systematic literature search was performed. Randomised controlled
trials (RCTs) with follow-up ≥ 5 years were included. Pooled proportions of
anatomical success, which was the primary outcome, rate of recurrent reflux at
the saphenofemoral junction (SFJ), and mean difference in venous clinical
severity score (VCSS) were compared using a z test or Student t test. Quality of
life data were assessed and described.
RESULTS: Three RCTs and 10 follow-up studies of RCTs were included of which 12
were pooled in the meta-analysis. In total, 611 legs were treated with EVLA, 549
with HL+S, 121 with UGFS, and 114 with HL+EVLA. UGFS had significantly lower
pooled anatomical success rates than HL+S, EVLA, and EVLA with high ligation:
34% (95% CI 26-44) versus 83% (95% CI 72-90), 88% (95% CI 82-92), and 88% (95%
CI 17-100) respectively; p ≤ .001. The pooled recurrent reflux rate at the SFJ
was significantly lower for HL+S than UGFS (12%, 95% CI 7-20, vs. 29%, 95% CI
21-38; p ≤ .001) and EVLA (12%, 95% CI 7-20, vs. 22%, 95% CI 14-32; p = .038).
VCSS scores were pooled for EVLA and HL+S, which showed similar improvements.
CONCLUSION: EVLA and HL+S show higher success rates than UGFS 5 years after GSV
treatment. Recurrent reflux rates at the SFJ were significantly lower in HL+S
than UGFS and EVLA. VCSS scores were similar between EVLA and HL+S.
Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier
Ltd. All rights reserved.
DOI: 10.1016/j.ejvs.2017.08.034
PMID: 29033337 [Indexed for MEDLINE]
