Diagnostic et traitement des varices des membres inférieurs - KCE

26 Varicose Veins KCE Reports 164
5.1.2.1 EVLT versus surgery (4 RCTs)
Efficacy
The efficacy outcome was reported in three of the four RCTs 81 93 96 i.e. recurrence of
GSV at one or two year follow-up through DUS scan. Recurrence of varicose veins was
similar for EVLT and surgery:
• Pronk et al. (2010) reported no significant difference in the development of
recurrent varicose veins at 1 year (10% for surgery and 9% for EVLT) 96 ;
• At 2 year follow-up, Christenson et al. (2010) found 7 of 98 limbs had reopened
compared with none in the surgical group but this result was not
significant 81 ;
• The Rasmussen trial did not report any difference in clinical recurrence rates
between EVLT (26%) and surgery (37%) groups after 2 years 93 .
Quality of life
In the four RCTs comparing EVLT to surgery, the improvement of quality of life was
similar between groups at final study follow-up. The study by Carradice et al. (2011)
comprehensively assessed quality of life outcomes using the UK SF-36 V1, EQ-5D and
AVVQ tools. The patients in the surgical arm experienced a significant decline in 5 of 8
SF-36 domains (p < 0.001 to p=0.049) due to increased pain and disability, whereas the
patients in the EVLT arm had deterioration in only two domains. From four weeks postprocedure
there were no differences between the groups 71 .
Pain
EVLT was associated with less pain post-procedure, with the exception of the Pronk et
al. trial (2010) whose EVLT patient’s experienced higher pain scores at day 7 (p < 0.01)
and day 14 (p < 0.01) 96 . However, this study used an older laser than the technologies
currently used.
Complications
Carradice et al (2011) 71 reported post operative complications in surgery (n=133) and
EVLT (n=137) patients. In this study, patients receiving surgery experienced higher rates
of sensory disturbance, (surgery n=13 versus EVLT n=4, p=0.02) haematoma (surgery
n=11 versus EVLT n=1, p=0.003) and infection (surgery n=8 versus EVLT n=2,
p=0.048) 71 . Bruising was more common after EVLT 81 .
Return to normal activities
Return to normal activities was similar between groups in the RCTs reporting this
outcome 81 96 with the exception of the Carradice trial where the surgical patients took
longer to return to normal activities (median 14 days versus 3 days; p < 0.001) 71 .
5.1.2.2 EVLT versus ligation of the SFJ (1 RCT)
Efficacy
One RCT evaluated ligation of the SFJ after EVLT using an EVLT comparator group.
This trial randomised 43 patients with bilateral varicose veins with SFJ incompetence
and GSV reflux from the groin to below the knee. The study found no difference
between the groups with respect to varicose vein recurrence measured by DUS at 2
year follow-up 82 .
Complications
Disselhoff et al., 2008, found no significant difference between the groups with respect
to bruising, pain score, tightness along the GSV and superficial thrombophlebitis. No
patient had a skin burn or a major complication 82 .