Interventions for great saphenous vein reflux: network meta-analysis of randomized clinical trials. Issue 3 (29th January 2021)

• Record Type: Journal Article
• Authors: Siribumrungwong, B; Wilasrusmee, C; Orrapin, S; Srikuea, K; Benyakorn, T; McKay, G; Attia, J; Rerkasem, K; Thakkinstian, A
• Is Part Of: British journal of surgery. Volume 108:Issue 3(2021)
• Page Start: 244
• Page End: 255
• Publication Date: 2021-01-29
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znaa101
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent. Methods: 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. Results: 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. Conclusion: 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. Abstract : A systematic review and network meta-analysis of interventions to treat great saphenous vein reflux was performed. Seventy-two RCTs were included. Anatomical failure was not significantly different between endovenous laser ablation (EVLA), radiofrequency ablation, cyanoacrylate closure and open surgery at early and mid-term follow-up. However, EVLA might result in poorer long-term outcome. Not enough adequate laparoscopic lymph node dissections