Attaran Robert, Edwards Matthew, Bunte Matthew C, Castro-Dominguez Yulanka, Fukaya Eri, Harth Karem, Kim Pamela, Firestone Scott, Senerth Emily, Morgan Rebecca L
Yale Heart and Vascular Center, Yale School of Medicine, New Haven, Connecticut.
Cardiology Associates of Michigan, Shelby Township, Michigan.
J Soc Cardiovasc Angiogr Interv. 2025 Jun 30;4(8):103730. doi: 10.1016/j.jscai.2025.103730. eCollection 2025 Aug.
Chronic venous disease (CVD) impacts more than 25 million adults in the United States and is associated with a host of symptoms that can adversely affect quality of life (QoL), such as leg discomfort, edema, and ulceration. Treatments for CVD range from conservative therapy centered around use of compression to more invasive approaches, such as ablation, sclerotherapy, phlebectomy, venoplasty, and stenting.
A systematic review was conducted to address 8 questions on the management of CVD that were formulated by the Society for Cardiovascular Angiography & Interventions (SCAI) Guideline Panel using the patient, intervention, comparator, outcome (PICO) format. Medical literature from January 1, 2008, through May 15, 2023, was searched using PubMed, Embase, and the Cochrane Central Register of Controlled Trials, except where an existing systematic review on compression therapy versus no intervention was updated with evidence from May 1, 2020, to May 15, 2023. Study selection was performed in duplicate; data extraction and risk of bias assessment were performed by 1 reviewer and reviewed by a second reviewer. Pooled effect estimates were calculated when applicable, and overall certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Our combined searches identified 3648 titles and abstracts, of which 19 met eligibility criteria and informed the technical review. Studies reported on healing rate and time to healing, disease recurrence, symptom severity, and QoL among patients who were treated with compression therapy, ablation, sclerotherapy, phlebectomy, and venoplasty or stenting. Compression therapy probably results in slightly faster and more complete venous ulcer healing compared with no compression. Ablation of the great saphenous vein ± small saphenous vein may improve healing rate and symptoms over conservative therapy alone, particularly for ulcer disease. Evidence is very uncertain for any effect on healing rate, symptom score, QoL, and disease recurrence associated with perforator vein ablation, venoplasty, and stenting for iliocaval obstruction, sclerotherapy, and phlebectomy of symptomatic varicose veins.
Data from this technical review will inform the Society for Cardiovascular Angiography and Interventions Guideline on Management of Chronic Venous Disease. The panel also identified research priorities based on areas where evidence to guide clinical practice is lacking or very uncertain.
在美国，慢性静脉疾病（CVD）影响着超过2500万成年人，并且与一系列可能对生活质量（QoL）产生不利影响的症状相关，如腿部不适、水肿和溃疡。CVD的治疗方法多种多样，从以使用弹力袜为主的保守治疗到更具侵入性的方法，如消融、硬化疗法、静脉切除术、静脉成形术和支架置入术。
进行了一项系统综述，以回答心血管造影和介入学会（SCAI）指南小组采用患者、干预措施、对照、结局（PICO）格式提出的关于CVD管理的8个问题。检索了2008年1月1日至2023年5月15日期间的医学文献，使用的数据库包括PubMed、Embase和Cochrane对照试验中央注册库，但关于弹力袜治疗与不干预对比的现有系统综述更新了2020年5月1日至2023年5月15日的证据。研究选择由两人独立进行；数据提取和偏倚风险评估由一名审阅者进行，另一名审阅者进行复核。在适用时计算合并效应估计值，并使用推荐分级的评估、制定与评价（GRADE）方法评估证据的总体确定性。
我们的综合检索共识别出3648篇标题和摘要，其中19篇符合纳入标准并为技术综述提供了信息。研究报告了接受弹力袜治疗、消融、硬化疗法、静脉切除术以及静脉成形术或支架置入术的患者的愈合率、愈合时间、疾病复发情况、症状严重程度和生活质量。与不使用弹力袜相比，弹力袜治疗可能会使静脉溃疡愈合稍快且更完全。大隐静脉±小隐静脉消融可能比单纯保守治疗更能提高愈合率和改善症状，尤其是对于溃疡疾病。关于穿通静脉消融、静脉成形术以及髂股静脉阻塞支架置入术、硬化疗法和有症状静脉曲张静脉切除术对愈合率、症状评分、生活质量和疾病复发的任何影响，证据非常不确定。
本技术综述的数据将为心血管造影和介入学会慢性静脉疾病管理指南提供参考。该小组还根据缺乏或非常不确定指导临床实践证据的领域确定了研究重点。
