A randomized clinical trial of isolated ambulatory phlebectomy versus saphenous thermal ablation with concomitant phlebectomy (SAPTAP Trial).

Autor:	Scheerders ERY; Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., van der Velden SK; Department of Dermatology, MohsA Clinics Skincentre, Eindhoven, the Netherlands., Goossens LMA; Erasmus School for Health, Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands., Hamann SAS; Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., de Maeseneer MGR; Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., Malskat WSJ; Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., de Mik L; Department of Dermatology, Isala Zwolle, Zwolle, the Netherlands., Nijsten TEC; Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands., van den Bos RR; Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	The British journal of surgery [Br J Surg] 2023 Feb 15; Vol. 110 (3), pp. 333-342.
DOI:	10.1093/bjs/znac388
Abstrakt:	Background: Current treatment of patients with saphenous trunk and tributary incompetence consists of truncal ablation with concomitant, delayed or no treatment of the tributary. However, reflux of the saphenous trunk may be reversible after treatment of the incompetent tributary. The aim of this study was to determine whether single ambulatory phlebectomy with or without delayed endovenous truncal ablation (SAP) is non-inferior to thermal endovenous ablation with concomitant phlebectomy (TAP), and whether SAP is a cost-effective alternative to TAP. Methods: A multicentre, non-inferiority RCT was conducted in patients with an incompetent great saphenous vein or anterior accessory saphenous vein with one or more incompetent tributaries. Participants were randomized to receive SAP or TAP. After 9 months, additional truncal treatment was considered for SAP patients with remaining symptoms. The primary outcome was VEnous INsufficiency Epidemiological and Economic Study Quality of Life/Symptoms (VEINES-QOL/Sym score) after 12 months. Secondary outcomes were, among others, cost-effectiveness, perceived improvement of symptoms, and anatomical success. Results: Some 464 patients received the allocated treatment (SAP 227, TAP 237). VEINES-QOL scores were 52.7 (95 per cent c.i. 51.9 to 53.9) for SAP and 53.8 (53.3 to 55.1) for TAP; VEINES-Sym scores were 53.5 (52.6 to 54.4) and 54.2 (54.0 to 55.6) respectively. Fifty-eight patients (25.6 per cent) in the SAP group received additional truncal ablation. Treatment with SAP was less costly than treatment with TAP. Conclusion: One year after treatment, participants who underwent SAP had non-inferior health-related quality of life compared with those who had TAP. Treatment with SAP was a cost-effective alternative to TAP at 12 months. Registration Number: NTR 4821 (www.trialregister.nl). (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.)
Databáze:	MEDLINE
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