Diagnostic et traitement des varices des membres inférieurs - KCE
Diagnostic et traitement des varices des membres inférieurs - KCE
Diagnostic et traitement des varices des membres inférieurs - KCE
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18 Varicose Veins <strong>KCE</strong> Reports 164<br />
4 RESULTS: INTERVENTIONS FOR THE<br />
TREATMENT OF VARICOSE VEINS<br />
4.1 IDENTIFIED STUDIES AND QUALITY APPRAISAL<br />
4.1.1 Systematic reviews<br />
4.1.1.1 Identified studies<br />
A total of 720 citations on the topic of interventions for varicose veins were identified<br />
in database searches (Figure 3). The supplementary searches of INAHTA member<br />
websites and hand searching yielded 20 additional references. The majority of citations<br />
were excluded on the basis of title and abstract; 71 citations were r<strong>et</strong>rieved in full and<br />
reviewed in more d<strong>et</strong>ail. On the basis of the full text, 32 reviews were included.<br />
4.1.1.2 Results of quality appraisal: 22 systematic reviews selected<br />
As a first step, quality appraisal of the 32 reviews was carried out to d<strong>et</strong>ermine their<br />
suitability for inclusion. Four criteria were used to appraise study quality, using the<br />
SIGN tool (see 2.2.2). Ten studies were excluded and 22 systematic reviews were<br />
included as d<strong>et</strong>ailed below.<br />
Excluded studies<br />
Eight 6 7 49-54 reviews were judged to have been undertaken using less rigorous m<strong>et</strong>hods<br />
and were labelled as “high risk of bias”:<br />
• Five studies 7 49-52 on multiple treatments;<br />
• Coleridge Smith <strong>et</strong> al. 53 on sclerotherapy;<br />
• Two reviews on EVLT 6 54 .<br />
One systematic review with low risk of bias 55 was additionally excluded because it<br />
reported little useful information. Another review 32 was also excluded because it<br />
evaluated transilluminated powered phlebectomy on varicosities which is out of scope<br />
of this review.<br />
Final selection: 22 systematic reviews<br />
Figure 3 shows that 22 of the reviewed studies were judged to be with a low risk of bias<br />
(see appendix 9.3): they were further included in the results 29 30 33-37 56-70 .Three of these<br />
included systematic reviews failed to address the quality of included studies but<br />
performed b<strong>et</strong>ter against other m<strong>et</strong>hodological markers 56 60 61 .<br />
The m<strong>et</strong>hodology of m<strong>et</strong>a-analysis was applied in three other systematic reviews, two<br />
by Luebke <strong>et</strong> al and one by Van Den Bos 32 59 68 . The validity of their conclusions is<br />
limited by the h<strong>et</strong>erogeneity of study types, interventions and study population.