Download the report - KCE
Download the report - KCE
Download the report - KCE
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
20 Varicose Veins <strong>KCE</strong> Reports 164<br />
4.1.2 Randomised controlled trials<br />
4.1.2.1 Identified studies<br />
The literature search for relevant RCTs was carried out in February 2011 identifying<br />
1913 citations (figure 4). An additional recently published RCT 71 was identified by one<br />
of <strong>the</strong> experts. The majority of citations were excluded on <strong>the</strong> basis of title and<br />
abstract; <strong>the</strong> o<strong>the</strong>r papers (n=42) were retrieved in full and reviewed in more detail.<br />
In addition, three potentially relevant trials (NCT00621062, NCT00529672, and<br />
NCT01103258) were identified in <strong>the</strong> ClinGov website (www.clinicaltrials.gov). The<br />
investigators were contacted to find out when <strong>the</strong> results of <strong>the</strong>se ongoing trials would<br />
be published.<br />
Three RCTs were excluded from <strong>the</strong> analysis because <strong>the</strong>y had already been discussed<br />
in <strong>the</strong> previous phase on systematic reviews. On <strong>the</strong> basis of <strong>the</strong> full text, nine o<strong>the</strong>r<br />
studies were excluded: eight were not RCTs and one lacked a comparator group.<br />
Therefore, 30 RCTs were assessed for <strong>the</strong>ir methodological quality.<br />
4.1.2.2 Results of quality appraisal for RCTs<br />
The majority of RCTs (n=24) were judged to have a low risk of bias and six RCTs high<br />
risk of bias (see appendix 9.5).<br />
Exclusion of 6 RCTs with high risk of bias<br />
Six RCTs 72-77 had a high risk of bias because authors did not <strong>report</strong> on <strong>the</strong> method of<br />
randomisation, <strong>the</strong> baseline characteristics of patient groups, or patient drop outs<br />
during <strong>the</strong> study:<br />
• Two RCTs on sclero<strong>the</strong>rapy: Hamel-Desnos (2010) 74 ,Yamaki (2009) 77 ;<br />
• Two RCTs on EVLT: Maurins (2009) 75 ,Theivacumar (2008) 76 ;<br />
• One RCT with EVLT versus RFA: Gale (2010) 73 ;<br />
• One RCT on surgery (comparison of 2 stripping techniques): Assadian<br />
(2008) 72 .<br />
24 RCTs with low risk of bias<br />
Twenty-four RCTs had a low risk of bias 71 78-100 .<br />
4.1.2.3 Final selection: 15 relevant RCTs<br />
However nine of <strong>the</strong> 24 RCTs were fur<strong>the</strong>r excluded as <strong>the</strong> interventions were not<br />
relevant for this review:<br />
• Two RCTs 97 98 evaluated <strong>the</strong> surgical technique CHIVA, a procedure not<br />
currently used in Belgium;<br />
• Three RCTs 91 100 evaluated <strong>the</strong> technique of cryostripping, also not currently<br />
used in Belgium;<br />
• Four o<strong>the</strong>r RCTs 79 80 84 87 had treatment arms that compared <strong>the</strong> same<br />
intervention; making <strong>the</strong> evidence for treatment difference not possible.<br />
o Blaise et al. (2010) 79 and Hamel-Desnos et al. (2008) 87 compared 1% vs 3%<br />
polidocanol foam use in sclero<strong>the</strong>rapy;<br />
o Doganci et al. 84 compared <strong>the</strong> 980 nm laser and bar-tip fibre with 1470<br />
nm laser and radial fibre (EVLT trial);<br />
o Carradice et al. (2009) 80 compared EVLT and EVLT combined with<br />
phlebectomy.<br />
Finally, 15 RCTs were included. The figure below shows <strong>the</strong> flow of studies in <strong>the</strong><br />
review.