Department of Dermatology, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Erasmus University Rotterdam, Rotterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2017 Dec;54(6):760-770. doi: 10.1016/j.ejvs.2017.08.034. Epub 2017 Oct 14.
The most frequently used treatment options for great saphenous vein incompetence are high ligation with stripping (HL+S), endovenous thermal ablation (EVTA), mainly consisting of endovenous laser ablation (EVLA) or radiofrequency ablation, and ultrasound guided foam sclerotherapy (UGFS). The objective of this systematic review and meta-analysis was to compare the long-term efficacy of these different treatment modalities.
A systematic literature search was performed. Randomised controlled trials (RCTs) with follow-up ≥ 5 years were included. Pooled proportions of anatomical success, which was the primary outcome, rate of recurrent reflux at the saphenofemoral junction (SFJ), and mean difference in venous clinical severity score (VCSS) were compared using a z test or Student t test. Quality of life data were assessed and described.
Three RCTs and 10 follow-up studies of RCTs were included of which 12 were pooled in the meta-analysis. In total, 611 legs were treated with EVLA, 549 with HL+S, 121 with UGFS, and 114 with HL+EVLA. UGFS had significantly lower pooled anatomical success rates than HL+S, EVLA, and EVLA with high ligation: 34% (95% CI 26-44) versus 83% (95% CI 72-90), 88% (95% CI 82-92), and 88% (95% CI 17-100) respectively; p ≤ .001. The pooled recurrent reflux rate at the SFJ was significantly lower for HL+S than UGFS (12%, 95% CI 7-20, vs. 29%, 95% CI 21-38; p ≤ .001) and EVLA (12%, 95% CI 7-20, vs. 22%, 95% CI 14-32; p = .038). VCSS scores were pooled for EVLA and HL+S, which showed similar improvements.
EVLA and HL+S show higher success rates than UGFS 5 years after GSV treatment. Recurrent reflux rates at the SFJ were significantly lower in HL+S than UGFS and EVLA. VCSS scores were similar between EVLA and HL+S.
大隐静脉功能不全最常用的治疗方法是高位结扎加剥脱术（HL+S）、静脉内热消融（EVTA），主要包括静脉内激光消融（EVLA）或射频消融，以及超声引导泡沫硬化疗法（UGFS）。本系统评价和荟萃分析的目的是比较这些不同治疗方法的长期疗效。
进行了系统的文献检索。纳入了随访时间≥5 年的随机对照试验（RCT）。使用 z 检验或学生 t 检验比较主要结局即解剖学成功率、隐股静脉交界处（SFJ）反流复发率以及静脉临床严重程度评分（VCSS）均值差异的汇总比例。评估并描述了生活质量数据。
纳入了 3 项 RCT 和 10 项 RCT 的随访研究，其中 12 项研究被纳入荟萃分析。共有 611 条腿接受了 EVLA 治疗，549 条腿接受了 HL+S 治疗，121 条腿接受了 UGFS 治疗，114 条腿接受了 HL+EVLA 治疗。UGFS 的汇总解剖成功率明显低于 HL+S、EVLA 和 HL+EVLA 结扎：34%（95%CI 26-44）比 83%（95%CI 72-90）、88%（95%CI 82-92）和 88%（95%CI 17-100）；p≤0.001。SFJ 处的汇总复发反流率 HL+S 明显低于 UGFS（12%，95%CI 7-20，vs. 29%，95%CI 21-38；p≤0.001）和 EVLA（12%，95%CI 7-20，vs. 22%，95%CI 14-32；p=0.038）。对 EVLA 和 HL+S 进行了 VCSS 评分汇总，显示出相似的改善。
5 年后，与 UGFS 相比，EVLA 和 HL+S 治疗大隐静脉的成功率更高。SFJ 处的复发反流率在 HL+S 明显低于 UGFS 和 EVLA。EVLA 和 HL+S 的 VCSS 评分相似。
