Diagnostic et traitement des varices des membres inférieurs - KCE

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24 Varicose Veins KCE Reports 164 Table 4 Overview of RCTs evaluating treatments for varicose veins Intervention Reference Number RFA versus EVLT Almeida 2009 78,Goode 201088, Shepherd 201094 3 RFA versus surgery Subramonia 2010 95 Helmy Elkaffas 2011 99 2 EVLT versus surgery Carradice 201171, Christenson 201081, Pronk 201096, 4 EVLT versus EVLT/ligation of SFJ (mixed treatment) Sclerotherapy (foam versus liquid) Sclerotherapy (foam) versus surgery Rasmussen 201093 Disselhoff 2008b 82 Ouvry 200890, Rabe 2008 92 Figueiredo 200985 Compression hosiery Houtermans-Auckel 200986 1 Drugs Martinez-Zapata 200889 1 Table 5. CEAP classification of patients in the included RCTs Intervention Reference CEAP RFA versus EVLT Almeida 2009 78 C2 >87% Goode 2010 88 C2-6 Shepherd 2010 94 C1-2 37% C3-4 57% C5-6 6% RFA versus surgery Subramonia 2010 95 C2 79 % C3 18% C4-6 3% Helmy Elkaffas 2011 99 C2 53% C3 30% C4 12% C5 5% EVLT versus surgery Carradice 2011 71 , C2-70% C3-6 30% Christenson 2010 81 , C2-6 Pronk 2010 96 , ≥2 Rasmussen 2010 93 C2-4 EVLT versus EVLT/ligation of Disselhoff 2008b 82 C2 SFJ (mixed treatment) Sclerotherapy (foam versus liquid) Ouvry 2008 90 C2-6 Rabe 2008 92 C2 44% C3 28% C4 19% C5 5% Figueiredo 2009 85 C5 – healed venous ulcers Sclerotherapy (foam) versus surgery Compression hosiery Houtermans-Auckel 2009 86 C2-3 Drugs Martinez-Zapata 2008 89 C1-6 1 2 1
KCE Reports 164 Varicose Veins 25 5 RESULTS BY INTERVENTION 5.1 ENDOVENOUS LASER THERAPY 5.1.1 Results from systematic reviews The NHS review from Rees 29 included four RCTs evaluating endovenous laser therapy (EVLT) 93 106-108 . All studies compared EVLT (with SFJ ligation) with surgery, SFV ligation and stripping. One study 108 enrolled patients with bilateral GSV varices and compared the techniques between the two legs. Follow-up periods were short, ranging from 16 weeks 106 to one year 107 . Patient satisfaction with the procedure was similar for both treatments across the four studies. In the study comparing treatment between each leg, 70 per cent of patients preferred the laser side (p=0.018) 108 . Likewise, pain scores were similar except in one trial, where higher post-operative pain was recorded in the surgery group 109 . Return to daily activities was faster for the EVLT group (two days versus seven days, p=0.001) in the Darwood et al., 2008 trial 107 . Conversely, Kalteis et al., 2008 106 found that the surgery patients returned to work sooner than the EVLT patients (14 days versus 20 days, p=0.054) although the EVLT patients in this trial had SFJ ligation as well, and 48% of EVLT patients underwent general anaesthesia compared with 34% in the surgery arm. However, the use of return to work is a poor outcome measure, given its dependency on the social security system. Overall, surgery was found to cause more oedema and bruising than EVLT. Postoperative infections were reported in the surgery group in two of the studies 106 107 . Phlebitis was more commonly reported in the EVLT group 107 . Skin burns and nerve damage were rare complications of EVLT. Efficacy outcomes were most commonly reported as occlusion rate after the procedure. All studies reported an occlusion rate in both treatment arms greater than 94% with follow-up of this outcome ranging from 30 days to 6 months Two RCTs 106 107 reported similar efficacy outcomes for EVLT and surgery as judged by post-operative assessment with colour duplex ultrasound and clinical assessment. 5.1.2 Results from randomised controlled trials Eight RCTs evaluating EVLT were found. • Three RCTs comparing EVLT to RFA (see RFA section) 78, 88, 94 ; • Four RCTs comparing EVLT with surgery 71 81 93 96 ; • One RCT comparing EVLT with a mixed intervention (EVLT and ligation of the SFJ) 82 . Two ongoing trials were identified from the clinicaltrials.gov search: a Swedish study (NCT00621062) comparing EVLT, RFA and sclerotherapy with surgery and a study (NCT00529672) from The Netherlands comparing EVLT and sclerotherapy with surgery.
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Diagnostic et traitement des varices des membres inférieurs - KCE

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