Bontinis Vangelis, Bontinis Alkis, Koutsoumpelis Andreas, Potouridis Anastasios, Giannopoulos Argirios, Rafailidis Vasileios, Chorti Angeliki, Ktenidis Kiriakos
Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
2nd Department of Surgery, Division of Vascular Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki 'G. Gennimatas', Thessaloniki, Greece.
Vasc Med. 2023 Oct;28(5):449-457. doi: 10.1177/1358863X231183997. Epub 2023 Jul 17.
We sought to assess the safety and efficacy of endovenous thermal ablation (EVTA) in treating large great saphenous veins (GSV) > 12 mm in diameter.
We performed a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 for comparative and noncomparative studies depicting EVTA in the treatment of GSV > 12 mm. Primary endpoints included GSV occlusion, technical success, deep vein thrombosis (DVT), and endovenous heat-induced thrombosis (EHIT). We conducted a comparative analysis between GSV > 12 mm and < 12 mm and a meta-regression analysis for two sets of studies, one including the whole dataset, containing treatment arms of comparative studies with GSV < 12 mm and one exclusively for GSV > 12 mm.
Seven studies, including 2564 GSV, depicting radiofrequency (RFA) and endovenous laser ablation (EVLA) were included. GSV > 12 mm occlusion, technical success, DVT, and EHIT estimates were 95.9% (95% CI: 93.6-97.8), 99.9% (95% CI: 98.9-100.0), 0.04% (95% CI: 0.0-3.4), and 1.6% (95% CI: 0.3-3.5). Meta-regression revealed a negative association between GSV diameter and occlusion for both the whole dataset ( < 0.01) and the > 12 mm groups ( = 0.04), GSV diameter and technical success for both groups ( < 0.01), ( = 0.016), and GSV diameter and EHIT only for the whole dataset ( = 0.02). The comparative analysis between GSV < 12 mm and GSV > 12 mm displayed an occlusion estimate of OR 1.79 (95% CI: 1.25-2.56) favoring small GSV.
Whereas we have displayed excellent occlusion and technical success results for the EVTA of GSV > 12 mm, our analysis has illustrated the unfavorable impact of GSV diameter on occlusion, technical success, and EHIT outcomes regardless of the 12 mm threshold. Potential parameter or device adjustments in a diameter-oriented fashion could further enhance outcomes.
我们旨在评估静脉内热消融术（EVTA）治疗直径大于12mm的大隐静脉（GSV）的安全性和有效性。
我们根据系统评价和Meta分析的首选报告项目（PRISMA）2020对描述EVTA治疗直径大于12mm的GSV的比较性和非比较性研究进行了系统评价。主要终点包括GSV闭塞、技术成功率、深静脉血栓形成（DVT）和静脉内热诱导血栓形成（EHIT）。我们对直径大于12mm和小于12mm的GSV进行了比较分析，并对两组研究进行了Meta回归分析，一组包括整个数据集，包含直径小于12mm的GSV的比较性研究的治疗组，另一组专门针对直径大于12mm的GSV。
纳入了7项研究，共2564条GSV，描述了射频消融（RFA）和静脉内激光消融（EVLA）。直径大于12mm的GSV闭塞、技术成功率、DVT和EHIT的估计值分别为95.9%（95%CI：93.6 - 97.8）、99.9%（95%CI：98.9 - 100.0）、0.04%（95%CI：0.0 - 3.4）和1.6%（95%CI：0.3 - 3.5）。Meta回归显示，对于整个数据集（<0.01）和直径大于12mm的组（=0.04），GSV直径与闭塞之间呈负相关；对于两组，GSV直径与技术成功率之间呈负相关（<0.01），（=0.016）；仅对于整个数据集，GSV直径与EHIT之间呈负相关（=0.02）。直径小于12mm的GSV与直径大于12mm的GSV的比较分析显示，闭塞估计值的OR为1.79（95%CI：1.25 - 2.56），有利于较小的GSV。
虽然我们展示了EVTA治疗直径大于12mm的GSV的出色闭塞和技术成功结果，但我们的分析表明，无论12mm的阈值如何，GSV直径对闭塞、技术成功率和EHIT结果都有不利影响。以直径为导向的潜在参数或设备调整可能会进一步改善结果。
