Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand.
Centre of Excellence in Applied Epidemiology, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand.
Br J Surg. 2021 Apr 5;108(3):244-255. doi: 10.1093/bjs/znaa101.
A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent.
A systematic review and network meta-analysis of RCTs was performed to compare rates of incomplete stripping or non-occlusion of the great saphenous vein with or without reflux (anatomical failure) at early, mid- and long-term follow-up; and secondary outcomes (reintervention and clinical recurrence) among intervention groups. The surface under the cumulative ranking curve (SUCRA) method was used to estimate the probability of the intervention with the lowest anatomical failure rates.
Some 72 RCTs were included. Comparisons of endothermal techniques with open surgery were mostly not significantly different, except for endovenous laser ablation (EVLA), which had higher long-term anatomical failure rates (pooled risk ratio (RR) 1.87, 95 per cent c.i. 1.14 to 3.07). Mechanochemical ablation had higher anatomical failure rates than radiofrequency ablation (RFA) (pooled RR 2.77, 1.38 to 5.53), and cyanoacrylate closure (CAC) had a RR 0.56 (0.34 to 0.93) times lower than either RFA or EVLA at the early term. Ultrasound-guided foam sclerotherapy had a higher risk of anatomical failure and reintervention than open surgery, with the lowest SUCRA value, and CAC was ranked first, third and first for best intervention for anatomical failure at early, mid and long term respectively. However, clinical recurrence rates were not significantly different between all comparisons.
Mechanochemical ablation and ultrasound-guided foam sclerotherapy performed poorly, with higher anatomical failure rates in the long term. The other treatment modalities had similar rates of anatomical failure in the short and mid term.
有多种血管内和开放手术干预措施可用于治疗大隐静脉反流。然而，治疗结果的比较一直不一致。
我们进行了一项系统评价和网络荟萃分析，纳入了 RCT，以比较在早期、中期和长期随访时存在或不存在反流（解剖学失败）的情况下，大隐静脉未完全剥离或未闭塞的发生率；以及干预组的次要结局（再次干预和临床复发）。采用累积排序曲线下面积（SUCRA）方法估计解剖学失败率最低的干预措施的概率。
共纳入 72 项 RCT。热消融技术与开放手术的比较大多无显著差异，但静脉内激光消融（EVLA）除外，其长期解剖学失败率较高（合并风险比（RR）1.87，95%置信区间 1.14 至 3.07）。机械化学消融的解剖学失败率高于射频消融（RFA）（合并 RR 2.77，1.38 至 5.53），而氰基丙烯酸酯闭合（CAC）在早期的 RR 为 0.56（0.34 至 0.93），低于 RFA 或 EVLA。超声引导泡沫硬化疗法的解剖学失败和再次干预风险高于开放手术，SUCRA 值最低，CAC 在早期、中期和长期的最佳解剖学失败干预方面分别排名第一、第三和第一。然而，所有比较之间的临床复发率无显著差异。
机械化学消融和超声引导泡沫硬化疗法表现不佳，长期解剖学失败率较高。其他治疗方式在短期和中期的解剖学失败率相似。
