Diagnostic et traitement des varices des membres inférieurs - KCE

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74 Varicose Veins KCE Reports 164 Reference High quality study? Number of studies included Hamel-Desnos 2009 60 Yes 8 - 6 (RCT's) for saphenous veins, 2 comparative trials for reticular veins and telangiectases Jia 2007 35 Yes Sixty-nine studies(eight RCTs, one registry study, three nonrandomized comparative study, 27 case series and five case reports, 24 conference abstracts. One study was unpublished NICE 2009 61 Yes 10 (2 RCTs, 4 case series, 4 case reports), Inclusion criteria Summary of Results primary varicose veins- divided into 2 groups - saphenous veins and reticular veins and telangiectases, this distinction may be crucial for conclusion varicose veins ( great and/or small saphenous vein incompetence) or varicosities in adults aged 16 years and over . patients with varicose veins Tisi 2006 62 Yes 17 RCTs Sclerotherapy versus other treatment options: a) Sclerotherapy versus graduated compression stockings for varicose veins with superficial venous incompetence. b) Sclerotherapy versus graduated compression efficacy results from a meta-analysis, greatly favour foam over liquid sclerotherapy : foam 76.8% (95% CI 71-82) versus liquid 39.5% (95% CI 33-46); p
KCE Reports 164 Varicose Veins 75 Reference High quality study? Number of studies included 9.4.7 Sclerotherapy RCTs from Rees et al., 2009 29 Study Follow-up Total No. of patients Inclusion criteria Summary of Results stockings or observation for varicose veins in the absence of superficial venous incompetence. c) Sclerotherapy versus laser treatment or no treatment (i.e. simple follow-up) in people with thread veins. 2. Comparison of different sclerosants 3. Comparison of injection techniques, bandaging and compression techniques and repeat treatment intervals. Methods Results Belcaro et al. 2000 115 10 years 121 Ultrasound-guided LSC (polidocanol) of GSV (n=32) compared with surgery to SFJ alone or surgery combined with sclerotherapy (n=33) Belcaro et al., 2003 116 10 years 887 887 patients with VV and SV incompetence were randomised to 6 different treatment options (LSC (n=123); high-dose LSC (n=112), closed loop ligation (n=132), stab avulsion (n=122), E- FSC (n=129), surgical ligation then LSC Bountouroglou et al., 2006 118 (n=131). 3 weeks and 3 months 58 Ligation of SFJ and stripping (n=28)vs FSC of GSV and ligation of SFJ (n=30) evidence supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins following surgery and thread veins. Sapheno-femoral incompetence at 10 years was 19% for sclerotherapy alone and 0% for the other treatment options. Distal venous incompetence was 44% for sclerotherapy, 36% for surgery alone and 16% for combined surgery and sclerotherapy. Decrease in venous reflux was generally comparable across all groups. Overall 51% of patients had new varicose veins at 10 years compared with 44% at 5 years. Low dose LSC is less effective than FSC and high dose LSC. Mean treatment time was 45 mins for foam and 85 mins for surgery. Mean return to work was 2 days (0-6 days) for foam and 8 days (5-20 days) for surgery (p
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Page 113 and 114: Referen ce Rabe 2008 92 Germany 11
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Diagnostic et traitement des varices des membres inférieurs - KCE

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