Dermody Meghan, Schul Marlin W, O'Donnell Thomas F
Cardiovascular Center, Tufts Medical Center, USA
Lafayette Regional Vein and Laser Center, IN, USA.
Phlebology. 2015 Jun;30(5):357-64. doi: 10.1177/0268355514529948. Epub 2014 Apr 3.
We assessed the incidence of venous thromboembolism following treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy using meta-analysis of published randomized controlled trials and case series.
Medline, Embase, Cochrane, and Clinical Trials Registry databases were searched from January 2000 through January 2013 for randomized controlled trials and large case series employing endovenous thermal ablation or foam sclerotherapy as a single modality for the treatment of great saphenous insufficiency, with concomitant postoperative duplex scanning. Pooled (stratified) incidence of venous thromboembolism with 95% confidence intervals was estimated using the DerSimonian–Laird procedure for random effects meta-analysis. A bootstrap analysis was performed to examine between-modality differences.
Twelve randomized controlled trials and 19 case series investigating endovenous thermal ablation (radio frequency ablation with VNUS/Covidien ClosureFAST™ catheter only, endovenous laser ablation, or both) were included. Data from 12 randomized controlled trials and 6 case series investigating nonproprietary foam preparations were analyzed. Estimated incidence of venous thromboembolism was low (mostly <1%) and similar across treatment modalities and study types.
Treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy is a common vascular intervention. The stratified incidence of venous thromboembolism appears to be low as reported in both randomized controlled trials and case series investigating these modalities. Although duplex scans were obtained postoperatively, a minority of studies specified protocols for venous thromboembolism detection.
我们通过对已发表的随机对照试验和病例系列进行荟萃分析，评估了大隐静脉功能不全经静脉内热消融或泡沫硬化疗法治疗后静脉血栓栓塞的发生率。
检索2000年1月至2013年1月期间的Medline、Embase、Cochrane和临床试验注册数据库，以查找采用经静脉内热消融或泡沫硬化疗法作为单一方式治疗大隐静脉功能不全并伴有术后双功扫描的随机对照试验和大型病例系列。使用DerSimonian-Laird随机效应荟萃分析程序估计静脉血栓栓塞的合并（分层）发生率及95%置信区间。进行了自抽样分析以检验不同治疗方式之间的差异。
纳入了12项研究经静脉内热消融（仅使用VNUS/Covidien ClosureFAST™导管进行射频消融、静脉内激光消融或两者皆用）的随机对照试验和19个病例系列。分析了12项研究非专利泡沫制剂的随机对照试验和6个病例系列的数据。静脉血栓栓塞的估计发生率较低（大多<1%），且在不同治疗方式和研究类型之间相似。
经静脉内热消融或泡沫硬化疗法治疗大隐静脉功能不全是一种常见的血管介入治疗。如在研究这些治疗方式的随机对照试验和病例系列中所报道，静脉血栓栓塞的分层发生率似乎较低。尽管术后进行了双功扫描，但少数研究明确了静脉血栓栓塞检测的方案。
