Diagnostic et traitement des varices des membres inférieurs - KCE

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Referen ce 94 Varicose Veins KCE Reports 164 Details of interventio n/ anaestheti c Details of compara tor/ anaesthe tic No. of patients Patient inclusion criteria including type of varicose vein setting 12&VCSS); return to normal activities and work; complication s at 6 weeks Subramo nia 2010 95 UK 1 site Hospital setting RFA (using VNUS ClosureFAS T) GA Conventio nal surgery GA RFA, n=47; conventio nal surgery, n=41 (34/128 legs exclude) 18-70 years; GSV reflux (primary or recurrent) on duplex imaging and requiring surgery Duplex scan confirmed suitability for RFA; fit for a general anaesthetic; allowing ambulation after the procedure Outcomes Methods Time of follow up Time to normal activities; intraoperativ e complication s; duration of procedure; postoperativ e morbidity; time to return to driving; patient satisfaction and QoL infiltrated along the length of the vein under US guidance; Segmental RFA, the first segment was treated with 2 RFA cycles, and the remainder of the vein was treated with one RFA cycle per 7-cm segment. Extrinsic pressure was applied over the vein during treatment cycles; EVLA: the laser was continually withdrawn delivering energy >60 J/cm to the vein wall, with a power setting of 11 W. Patients with varicosities were treated with concomitant phlebectomies using a standard technique (Oesch hook) and all phlebectomy sites were sutured with 6/0 polypropylene.Tumescent anaesthesia was not used for phlebectomy incisions. Both groups: a single SC prophylactic dose of low molecular weight heparin at the time of intervention; operations under general anaesthesia; phlebectomy hooks used with simultaneous avulsion of varicosities that had been marked before operation; RFA: With the patient in the reverse Trendelenburg position,the GSV was accessed percutaneously by the Seldinger technique and a 6- or 8-Fr FAST-CATHTM Haemostasis Introducer inserted; the VNUSClosure PLUS intravascular catheter with bipolar electrodes was introduced through the sheath and positioned in the GSV with its tip just below the entry of the superficial epigastric vein.The target temperature was set at 85°C. The ablation was commenced 1 and 5 weeks after treatment Results-efficacy Including recurrence to work within 7 days in RFA and EVLA groups respectively. Similar results for back to normal activities Time to normal activities (3 days vs 12.5 days), work (10 days vs 18.5 days)and driving (4 days vs 7 days) RFA significantly shorter than conventional surgery; Duration of procedure: significantly shorter for conventional surgery; Patient satisfaction: (VAS score) significantly higher in RFA group (10 vs 8.5). Resultscomplication s/adverse events first 3 days and in the first 10 days; complications: 2 major : one pulmonary embolus after RFA and one lymphatic leak after EVLA Complications: significantly higher rate of cutaneous sensory abnormalities in conventional surgery; Postoperative morbidity: pain in first week (VAS score 1.70 vs 4.00) p=0.001 and analgesic requirements (days 2 vs 10)p=0.011 were significantly less in the RFA Results- QoL(including scale used) between the two groups in AVVQ, VCSS or SF-12 in either the physical component or mental component score QoL (AVVQ data): significantly greater improvement after RFA Interpretation of value of RCT for decision making pain and only as short follow-up RFA patients experienced less pain and recovered more quickly as demonstrated by patient satisfaction and QoL scores. Study limited by short-term follow-up and patients, operators and researchers not blinded. Valuable RCT for short term outcomes of RFA.
Referen ce Referen ce Figueired o 2009 85 Brazil 1 site Outpatie nt clinic KCE Reports 164 Varicose Veins 95 Details of interventio n/ anaestheti c Details of compara tor/ anaesthe tic No. of patients Patient inclusion criteria including type of varicose vein 9.6.3 Included RCTs evaluating sclerotherapy Details of interventio n/ anaestheti c Ultrasound – guided foam sclerotherap y Details of compara tor/ anaesthe tic Surgical stripping Regional anaestheti c No. of patients Ultrasoun d guided foam therapy N=27 but average 2.1 sessions/p atient Surgery N= 29 Patient inclusion criteria including type of varicose vein Primary varicose veins CEAP C5 Ep As Pr (healed venous ulcers). No previous treatment. 18-70 years Outcomes Methods Time of follow up just distal to the entry of superficial epigastric vein and the catheter was pulled back at the rate of 1·5–2 cm per min for the first 3 cm and 2–3 cm per min for the remainder of the procedure; Conventional surgery: patient in the Trendelenburg position; through a skin-crease groin incision the SFJ was exposed and tributaries of the GSV were ligated and divided; the GSV was ligated and divided close to the SFJ (high ligation); a perforate–invagination (PIN) stripper was passed down the open distal end of the vein to emerge at knee level and the skin to retrieve the stripper. The vein was secured to the upper end of the stripper, which was retrieved by pulling it down to knee level and out of the exit wound, thus stripping the vein. Outcomes Methods Time of follow up Venous clinical severity scores based on pain, oedema, inflammation , hyperpigmen tation and lipodermato sclerosis. Surgery: saphenofemoral or saphenopopliteal ligation combined with saphenous stripping and phlebectomy for varicose saphenous tributaries and ligation of incompetent perforating veins. All surgical procedures carried out under regional anaesthesia. Sclerotherapy : Injections of foam were made into the saphenous trunk using a 20-gauge needle. The accessory veins were cannulated 30 and 60 days postop; then 6 months or 180 days Results-efficacy Including recurrence Results-efficacy Including recurrence The mean venous clinical severity scores measured before and after 180 days were as follows: Surgery group - pain: before 1.97 standard deviation (SD) 0.19, 180 days 0.72 SD 0.53; oedema: before 1.66 Resultscomplication s/adverse events group in the first week post treatment Resultscomplication s/adverse events No serious adverse events were associated with any of the treatments. Most frequent minor complication in the surgery is suture Results- QoL(including scale used) Results- QoL(including scale used) Interpretation of value of RCT for decision making Interpretation of value of RCT for decision making No QOL results Small sample size and and short follow-up.
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Diagnostic et traitement des varices des membres inférieurs - KCE

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