Diagnostic et traitement des varices des membres inférieurs - KCE

2 Varicose Veins KCE Reports 164
4.3 OVERVIEW OF INCLUDED RCTS ....................................................................................................... 23
5 RESULTS BY INTERVENTION ................................................................................... 25
5.1 ENDOVENOUS LASER THERAPY ........................................................................................................ 25
5.1.1 Results from systematic reviews ................................................................................................. 25
5.1.2 Results from randomised controlled trials ............................................................................... 25
5.1.3 Summary: Endovenous Laser Therapy ....................................................................................... 27
5.2 RADIOFREQUENCY ABLATION.......................................................................................................... 27
5.2.1 Results from systematic reviews ................................................................................................. 27
5.2.2 Results from randomised controlled trials ............................................................................... 27
5.2.3 Summary: Radiofrequency ablation ............................................................................................ 29
5.3 SCLEROTHERAPY ..................................................................................................................................... 29
5.3.1 Results from systematic reviews ................................................................................................. 29
5.3.2 Results from randomised controlled trials ............................................................................... 29
5.3.3 Summary: Sclerotherapy ............................................................................................................... 30
5.4 SURGERY ..................................................................................................................................................... 31
5.5 COMPRESSION HOSIERY ....................................................................................................................... 31
5.6 DRUGS.......................................................................................................................................................... 32
5.6.1 One Cochrane review on the effect of phlebotonics for chronic venous insufficiency .. 32
5.6.2 Lack of evidence in one RCT ....................................................................................................... 32
5.7 OTHER CONSERVATIVE TREATMENTS ............................................................................................ 32
6 SAFETY CONSIDERATIONS ...................................................................................... 33
6.1 ENDOVENOUS LASER THERAPY ........................................................................................................ 33
6.2 RADIOFREQUENCY ABLATION.......................................................................................................... 33
6.3 SCLEROTHERAPY ..................................................................................................................................... 34
6.4 SURGERY ..................................................................................................................................................... 34
6.5 SUMMARY: SAFETY .................................................................................................................................. 35
7 ANAESTHESIA .............................................................................................................. 36
7.1 DESCRIPTION OF ANAESTHESIA IN THE INCLUDED RCTS ..................................................... 36
7.2 ANAESTHESIA SUMMARY ...................................................................................................................... 36
8 SUMMARY OF FINDINGS AND DISCUSSION ........................................................ 38
8.1 SUMMARY OF FINDINGS ....................................................................................................................... 38
8.1.1 Diagnostic: duplex ultrasound is the standard procedure ..................................................... 38
8.1.2 Treatment options: comparable efficacy and complications ................................................ 38
8.1.3 Heterogenous anaesthetic procedures...................................................................................... 38
8.1.4 Coherence of the results with other recent publications ..................................................... 39
8.2 TRANSFERABILITY OF RESULTS TO THE BELGIAN HEALTH CARE SETTING ? ................. 39
8.3 STRENGTHS AND LIMITATIONS OF THIS SYSTEMATIC REVIEW ........................................... 39
8.3.1 Strengths of this review ................................................................................................................ 39
8.3.2 Methodological limitations of the included studies ................................................................. 39
8.4 SUGGESTIONS FOR FURTHER RESEARCH ...................................................................................... 40
8.5 KEY POINTS OF THE REPORT ............................................................................................................. 41
9 APPENDICES ................................................................................................................. 42
9.1 ADDITIONAL HANDSEARCHING ...................................................................................................... 42
9.2 DIAGNOSTIC STUDIES: QUALITY APPRAISAL AND DETAILED RESULTS ABOUT THE
USE OF HAND-HELD DOPPLER .......................................................................................................... 44
9.2.1 Quality items derived from QUADAS tool .............................................................................. 44
9.2.2 Quality appraisal of varicose vein diagnostic studies .............................................................. 45
9.2.3 Data extraction table for Diagnostic studies (including hand-held Doppler) .................... 46
9.2.4 Overview of included diagnostic studies for hand-held Doppler ......................................... 57
9.2.5 Clinical Consequences of the findings: hand-held Doppler versus Colour duplex
ultrasound ..................................................................................................................................................... 60
9.3 QUALITY APPRAISAL FOR INCLUDED SYSTEMATIC REVIEWS ................................................ 62
9.4 DATA EXTRACTION TABLE FOR INCLUDED SYSTEMATIC REVIEWS .................................. 66
9.4.1 Reviews evaluating multiple treatments .................................................................................... 66