Malskat WSJ, Engels LK, Hollestein LM, Nijsten T, van den Bos RR, et al.
European journal of vascular and endovascular surgery : the official journal of the European So.... Date of publication 2019 Aug 1;volume 58(2):230-242.
1. Eur J Vasc Endovasc Surg. 2019 Aug;58(2):230-242. doi:
10.1016/j.ejvs.2018.10.036. Epub 2019 Jun 21.
Commonly Used Endovenous Laser Ablation (EVLA) Parameters Do Not Influence
Efficacy: Results of a Systematic Review and Meta-Analysis.
Malskat WSJ(1), Engels LK(2), Hollestein LM(2), Nijsten T(2), van den Bos RR(2).
Author information:
(1)Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands. Electronic
address: w.malskat@erasmusmc.nl.
(2)Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands.
Comment in
Eur J Vasc Endovasc Surg. 2019 Aug;58(2):243. doi:
10.1016/j.ejvs.2019.04.023.
OBJECTIVES: The objective of this systematic review and meta-analysis was to
summarise available randomised controlled trials (RCTs) of EVLA efficacy, and to
define the differences in success rate of variations in wavelength, administered
energy, outcome definition, and follow up period.
METHODS: A literature search was conducted in Embase, Medline (Ovid-SP),
Cochrane Central Database, and Web of Science from inception to November 2017.
RCTs with follow up of more than three months were included. The studied outcome
was the proportion of patients with EVLA treatment success, defined as absence
of reflux or occlusion of the great saphenous vein (GSV). Pooled proportions of
anatomical success were compared. Subgroup and meta-regression analysis included
wavelengths (short [810, 940, and 980 nm], long [1470, 1500, and 1920 nm]),
amount of energy (≤50 J/cm, > 50 J/cm), follow up (≤1 year, > 1 year), outcome
definition (occlusion, no reflux), and quality of the studies (low risk of bias,
unclear/high risk of bias).
RESULTS: Twenty-eight RCTs, with a total of 2829 GSVs were included. The overall
success rate of EVLA was 92% (95% CI 90-94%, I2 = 68%). In subgroup analysis, no
statistically significant differences were found for long or short wavelengths
(95% [95% CI 91-97%] vs. 92% [95% CI 89-94%], p = .15), high or low administered
energy (93% [95% CI 89-95%] vs. 92% [95% CI 90-94%], p = .99), long or short
follow up (89% [95% CI 84-93%] vs. 93% [95% CI 91-95%], p = .13) and outcome
definition (occlusion group 94% [95% CI 91-96%] vs. absence of reflux group 91%
[95% CI 87-94%], p = .26). Studies with low risk of bias reported a
significantly higher success rate than high or unclear risk of bias (93% [95% CI
90-95%] vs. 89% [95% CI 83-93%], p = .04).
CONCLUSIONS: The overall success rate of EVLA is high (92%), even with
increasing follow up. Commonly used parameters of EVLA (wavelength, administered
energy, and outcome definition) have no influence on the treatment success rate.
Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier
B.V. All rights reserved.
DOI: 10.1016/j.ejvs.2018.10.036
PMID: 31230868 [Indexed for MEDLINE]
