Abstract
Great saphenous vein insufficiency (GSVI) significantly impacts the quality of life of affected individuals, and various interventions, both minimally invasive and surgical, have been developed to treat it. This systematic review and network meta-analysis evaluate the available interventions for GSVI, comparing their technical success rates, recurrence rates, and post-intervention outcomes, including pain and patient-reported quality of life.
Methods
A comprehensive literature search was conducted across four electronic databases to identify relevant studies. A total of 75 studies involving 12,196 patients were included. The analysis employed risk ratios (RRs) for binary outcomes and mean differences (MDs) for continuous outcomes, with a 95% confidence interval. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of included studies.
Results
Among the interventions, Endo-Venous Laser Ablation (EVLA) combined with High Ligation and Stripping (HL/S) demonstrated higher technical success rates compared to Ultrasound-Guided Foam Sclerotherapy (UGFS) and invagination stripping, which showed inferior results. Conservative Hemodynamic Cure for Venous Insufficiency and Varicose Veins (CHIVA) had significantly lower recurrence rates (RR: 0.35 [0.15; 0.79]) compared to Radiofrequency Ablation (RFA), while RFA was more effective in preventing recurrence than HL/S and Mechanochemical Ablation (MOCA) (RR: 0.63 [0.41; 0.97] and 0.18 [0.03; 0.95], respectively). Endo-Venous Steam Ablation (EVSA) emerged as the most effective intervention for reducing post-intervention pain, with a mean difference of -2.73 [-3.72; -1.74] compared to HL/S. In terms of patient-reported outcomes, the analysis favored MOCA, showing improved scores on the Aberdeen Varicose Vein Questionnaire with a mean difference of -6.88 [-12.43; -1.32] compared to HL/S. The safety profiles of the different interventions did not show significant differences.
Conclusion
This study revealed substantial variations in the outcomes of different interventions for GSVI. CHIVA was associated with lower recurrence rates, while EVSA was the most effective in reducing post-intervention pain. MOCA consistently demonstrated superior results in enhancing the quality of life and accelerating recovery. These findings highlight the importance of considering individual patient needs when selecting treatment options for GSVI.
Source:
Juhani, A. A., Abdullah, A., Alyaseen, E. M., Dobel, A. A., Albashri, J. S., Alalmaei, O. M., et al. (2024). Interventions for great saphenous vein insufficiency: A systematic review and network meta-analysis. Vascular. https://doi.org/10.1177/17085381241273098