University of Limerick, School of Medicine, Limerick, Ireland.
Department of Vascular Surgery, University Hospital Galway, Ireland.
Ann Surg. 2022 Feb 1;275(2):e324-e333. doi: 10.1097/SLA.0000000000004914.
To determine the most effective modality of intervention to treat saphenous vein insufficiency.
Endovenous therapies have instigated a paradigm shift in the management of superficial venous incompetence. When compared with open surgery, endovenous interventions (foam sclerotherapy, radiofrequency ablation, endovenous laser ablation (EVLA), mechanochemical ablation, and CAE closure) potentially offer reduced morbidity with similar procedural efficacy.
A systematic review and series of network meta-analyses of randomized controlled trials were performed assessing risks of procedural failure (within 6-weeks) and recurrence (6-weeks to 5-years), defined by ultrasound, between the different modalities of intervention for superficial venous incompetence. Treatment comparisons addressing risks of common adverse events, venous clinical severity score, and pain were also performed.
A systematic search identified 51 articles, describing 36 randomized controlled trials, incorporating 7576 limbs. Outcome data on 10 modalities of intervention were analyzed up to 5-year follow-up. CAE resulted in the lowest risk of procedural failure within 6-weeks. Foam sclerotherapy had the highest risk of recurrence while high ligation with stripping (HLS) and Conservatrice Hemodynamique de l'Insuffisance Veineuse en Ambulatoire were ranked best to reduce long-term recurrence. No intervention increased risks of venous thromboembolism and there was minimal difference in morbidity between treatments. All interventions improved venous clinical severity score (range -1.02 to -4.95), however, radiofrequency ablation demonstrated the greatest improvement, followed by EVLA and HLS between 2 to 5-years. EVLA was associated with the highest risk of pain, while mechanochemical ablation offered the least.
Although CAE offered the lowest risk of initial procedural failure, HLS resulted in lower rates of long-term recurrence without considerably increasing morbidity when compared with other endovenous options.
确定治疗大隐静脉功能不全最有效的干预方式。
静脉内治疗在治疗浅表静脉功能不全方面引发了范式转变。与开放手术相比，静脉内干预（泡沫硬化疗法、射频消融、静脉内激光消融 (EVLA)、机械化学消融和 CAE 闭合）具有潜在的较低发病率和相似的程序疗效。
对随机对照试验进行了系统评价和一系列网络荟萃分析，评估了不同干预方式治疗浅表静脉功能不全的超声定义的程序失败（6 周内）和复发（6 周到 5 年）的风险，还进行了治疗比较，以评估常见不良事件、静脉临床严重程度评分和疼痛的风险。
系统搜索确定了 51 篇文章，描述了 36 项随机对照试验，共纳入 7576 条肢体。对 10 种干预方式的结果数据进行了分析，随访时间长达 5 年。CAE 在 6 周内程序失败的风险最低。泡沫硬化疗法的复发风险最高，而高位结扎加剥脱术 (HLS) 和 Conservatrice Hemodynamique de l'Insuffisance Veineuse en Ambulatoire 被评为降低长期复发的最佳方法。没有一种干预措施会增加静脉血栓栓塞的风险，而且治疗之间的发病率差异很小。所有干预措施均改善了静脉临床严重程度评分（范围 -1.02 至 -4.95），但射频消融显示最大的改善，其次是 EVLA 和 HLS 在 2 至 5 年内。EVLA 与最高的疼痛风险相关，而机械化学消融的疼痛风险最低。
尽管 CAE 初始程序失败的风险最低，但与其他静脉内治疗方法相比，HLS 导致长期复发的风险较低，且发病率没有显著增加。
