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18 Varicose Veins KCE Reports 164
4 RESULTS: INTERVENTIONS FOR THE
TREATMENT OF VARICOSE VEINS
4.1 IDENTIFIED STUDIES AND QUALITY APPRAISAL
4.1.1 Systematic reviews
4.1.1.1 Identified studies
A total of 720 citations on the topic of interventions for varicose veins were identified
in database searches (Figure 3). The supplementary searches of INAHTA member
websites and hand searching yielded 20 additional references. The majority of citations
were excluded on the basis of title and abstract; 71 citations were retrieved in full and
reviewed in more detail. On the basis of the full text, 32 reviews were included.
4.1.1.2 Results of quality appraisal: 22 systematic reviews selected
As a first step, quality appraisal of the 32 reviews was carried out to determine their
suitability for inclusion. Four criteria were used to appraise study quality, using the
SIGN tool (see 2.2.2). Ten studies were excluded and 22 systematic reviews were
included as detailed below.
Excluded studies
Eight 6 7 49-54 reviews were judged to have been undertaken using less rigorous methods
and were labelled as “high risk of bias”:
• Five studies 7 49-52 on multiple treatments;
• Coleridge Smith et al. 53 on sclerotherapy;
• Two reviews on EVLT 6 54 .
One systematic review with low risk of bias 55 was additionally excluded because it
reported little useful information. Another review 32 was also excluded because it
evaluated transilluminated powered phlebectomy on varicosities which is out of scope
of this review.
Final selection: 22 systematic reviews
Figure 3 shows that 22 of the reviewed studies were judged to be with a low risk of bias
(see appendix 9.3): they were further included in the results 29 30 33-37 56-70 .Three of these
included systematic reviews failed to address the quality of included studies but
performed better against other methodological markers 56 60 61 .
The methodology of meta-analysis was applied in three other systematic reviews, two
by Luebke et al and one by Van Den Bos 32 59 68 . The validity of their conclusions is
limited by the heterogeneity of study types, interventions and study population.