Interventions for great saphenous vein insufficiency: A systematic review and network meta-analysis.

Autor:	Juhani AA; Faculty of medicine and surgery,.King Abdulaziz University Hospital, Jeddah, Saudi Arabia., Abdullah A; Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia., Alyaseen EM; College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain., Dobel AA; College of Medicine, Taif University, Taif, Saudi Arabia., Albashri JS; College of Medicine, University of Jeddah, Jeddah, Saudi Arabia., Alalmaei OM; College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia., Salem Alanazi YM; College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia., Almutairi DR; College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia., Alqahtani LN; College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia., Alanazi SA; Al-Jouf Medical College, Al-Jouf University, Saudi Arabia.
Jazyk:	angličtina
Zdroj:	Vascular [Vascular] 2024 Aug 16, pp. 17085381241273098. Date of Electronic Publication: 2024 Aug 16.
DOI:	10.1177/17085381241273098
Abstrakt:	Background: Great saphenous vein insufficiency (GSVI) adversely affects the quality of life of affected individuals. Minimally invasive endo-venous ablation techniques have emerged as effective and safe treatments, despite the longstanding use of surgical interventions. We aim in our study to evaluate all the available interventions in the literature, either endo-venous or conventional approaches for the treatment of GSVI. Methods: A thorough search was performed across four electronic databases to identify relevant studies. A frequentist network meta-analysis (NWM) was executed on the combined data to derive network estimates pertaining to the outcomes of concern. Risk ratios (RRs) were employed as the effect size metric for binary outcomes, while mean differences (MDs) were utilized for continuous outcomes, each reported with a 95% confidence interval. The qualitative review was conducted employing the Cochrane risk of bias assessment tool 1. Results: Our NWM included 75 studies encompassing 12,196 patients. Regarding technical success rate within the first 5 years after treatment, Endo-venous Laser Ablation (EVLA) with High Ligation and Stripping (HL/S), EVLA alone, Cyanoacrylate Adhesive Injection, cryostripping, HL/S and Radiofrequency Ablation (RFA) were significantly better than Ultrasound-Guided Foam Sclerotherapy and F-care. Also, invagination stripping was inferior to all interventions. Conservative Hemodynamic Cure for Venous Insufficiency and Varicose Veins (CHIVA) demonstrated a significantly lower recurrence rate with a RR of 0.35 [0.15; 0.79] compared to RFA, but RFA was more effective in recurrence prevention than HL/S and Mechanochemical Ablation (MOCA), with a RR of 0.63 [0.41; 0.97] and 0.18 [0.03; 0.95], respectively. Endo-venous Steam Ablation (EVSA) emerged as the most effective in reducing post-intervention pain, showing a MD of -2.73 [-3.72; -1.74] compared to HL/S. In Aberdeen Varicose Vein Questionnaire outcome, our analysis favored MOCA over most studied interventions, with an MD of -6.88 [-12.43; -1.32] compared to HL/S. Safety outcomes did not significantly differ among interventions. Conclusion: Our findings revealed significant variations in the technical success rates, recurrence rates, and post-intervention pain levels among different interventions. CHIVA exhibited enhanced performance in terms of lower recurrence rates, while EVSA emerged as a promising choice for mitigating post-intervention pain. Additionally, our analysis underscored the significance of patient-reported outcomes, with MOCA consistently yielding favorable results in terms of enhancing quality of life and expediting the return to regular activities. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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