O'Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD, et al.
Journal of vascular surgery. Venous and lymphatic disorders. Date of publication 2016 Jan 1;volume 4(1):97-105.
1. J Vasc Surg Venous Lymphat Disord. 2016 Jan;4(1):97-105. doi:
10.1016/j.jvsv.2014.11.004. Epub 2015 Apr 11.
Recurrence of varicose veins after endovenous ablation of the great saphenous
vein in randomized trials.
O'Donnell TF(1), Balk EM(2), Dermody M(3), Tangney E(3), Iafrati MD(3).
Author information:
(1)CardioVascular Center, Tufts Medical Center, Boston, Mass. Electronic
address: todonnell@tuftsmedicalcenter.org.
(2)Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, Mass.
(3)CardioVascular Center, Tufts Medical Center, Boston, Mass.
BACKGROUND: Recurrence of varicose veins after surgery (REVAS) for saphenous
incompetence has been well described after ligation and stripping (L&S) but not
after the now most frequently performed method of saphenous ablation, endovenous
ablation (EVA). The purpose of this study was to define the overall incidence of
REVAS as well as both the sites of reflux and the causes of REVAS through a
systematic review and meta-analysis of randomized controlled trials (RCTs) for
EVA. These studies have the advantage of prospectively collected data and a
uniform duplex follow-up.
METHODS: We searched databases (January 1, 2000 through July 1, 2014) for
published RCTs evaluating EVA treatment of great saphenous vein (GSV)
incompetence that employed endovenous laser ablation or radiofrequency ablation.
RCTs were eliminated that (1) did not have follow-up of at least 2 years, (2)
did not obtain postoperative duplex scans, (3) did not clearly report the
incidence of recurrent varicosities after GSV ablation, and (4) treated the
small saphenous or anterior accessory saphenous veins.
RESULTS: Of the 68 studies screened, 20 RCTs that employed EVA of the GSV were
identified. Eight had a follow-up of at least 2 years, but one was eliminated
because of lack of information on both the site and cause of REVAS. The
resultant seven RCTs provided eight comparisons (one study compared both types
of EVA to a comparator arm): three used radiofrequency ablation, and five
employed endovenous laser ablation. Overall recurrent varicose veins developed
in 125 limbs after EVA (22%), with no difference in the incidence vs the L&S
group (22%) based on the number of limbs available at the time of
the development of recurrence for both groups, but this incidence is dependent
on the length of follow-up after the initial treatment. The two studies with
serial follow-up showed an approximate doubling of REVAS over time for both EVA
and L&S. By contrast, the cause of REVAS was different between the two methods.
Neovascularization occurred in only two limbs (2%) after EVA vs 18 (18%) in the
L&S group. Recanalization was the most common cause of REVAS for EVA (32%; 40 of
125 limbs), followed by the development of anterior accessory saphenous vein
incompetence (19%; 23 of 125 limbs). In contrast to other reports, incompetent
calf perforating veins were an infrequent cause of REVAS (7%; eight of 125).
CONCLUSIONS: There is no difference in the incidence of REVAS for EVA vs L&S,
but the causes of REVAS are different with L&S, which has important implications
for treatment.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All
rights reserved.
DOI: 10.1016/j.jvsv.2014.11.004
PMID: 26946904 [Indexed for MEDLINE]
