Diagnostic et traitement des varices des membres inférieurs - KCE

30 Varicose Veins KCE Reports 164
5.3.2.1 Liquid sclerotherapy versus foam sclerotherapy (2 RCTs)
Efficacy
No RCTs measured clinical outcomes (CEAP classification): both RCTs evaluated the
efficacy of the interventions based on the results of Doppler-ultrasound.
In the first trial from Rabe et al. (2008) elimination of reflux was more successful in the
foam group (69%) compared with the liquid group (27%) (p < 0.0001) 92 at three months.
In the second trial from Ouvry et al. (2008), at three weeks post-intervention, similar
efficacy results were seen (85% foam versus 35% liquid; p < 0.001) 90 . At two year
follow-up, these rates had dropped to 12% in the liquid group (4 patients) and 53% in
the foam group (25 patients) but these results are based on low patient numbers due to
high drop-out rates 90 .
Quality of life and patient satisfaction
Quality of life data was lacking in these trials. Rabe et al. (2008) found that patient
satisfaction was significantly higher in the foam group compared with the liquid group 92 .
Complications
There was no difference in the adverse event data between the groups 92 . Adverse
events most commonly reported for sclerotherapy included pain, haematoma,
phlebitis/thrombophlebitis and pigmentation or hyperpigmentation.
5.3.2.2 Foam sclerotherapy versus surgery (1 RCT)
Efficacy
At 180 day follow-up in the foam sclerotherapy compared with surgery trial, 90% of
foam sclerotherapy patients had saphenous vein obliteration compared with 78% in the
surgery group with a non-significant difference between the two methods 85 .
Complications
There was no difference in the adverse event data between the groups. The most
frequent complications were suture dehiscence in the surgery group and thrombus not
requiring drainage in the sclerotherapy group 85 .
5.3.3 Summary: Sclerotherapy
• The advantage of sclerotherapy is that no anaesthesia is required;
• The studies provided a follow-up to two years for foam sclerotherapy and to
10 years for liquid sclerotherapy;
• There is evidence of moderate quality to support a similar efficacy
(occlusion rates) of foam sclerotherapy, liquid sclerotherapy and surgery
with follow-ups to 2 years but there are few data on clinical efficacy;
• Evidence of low quality suggests that surgery performs better than liquid
sclerotherapy at 10 years;
• Adverse events reported for sclerotherapy included pain, haematoma,
phlebitis/thrombophlebitis, thrombosis, transient neurological symptoms
and pigmentation.