Introduction
Lower limb varicose veins are a common chronic venous insufficiency (CVI) disease that affects the quality of life for a large global population. Traditional treatment methods mainly include sclerotherapy and vein stripping, while in the past 20 years, technologies such as laser, radiofrequency ablation, and adhesive closure of the saphenous vein trunk have also been applied. However, in recent years, CHIVA (Conservative Hemodynamic Correction of Venous Insufficiency), an outpatient local anesthesia treatment based on hemodynamic analysis and vein preservation, has attracted significant attention for its advantages in reducing recurrence rates and improving patients’ quality of life.
Research Methods
Extensive literature searches were conducted in globally renowned databases including MEDLINE, Embase, and Cochrane. A total of over 39 RCT studies were identified, involving more than 6000 limbs, which were finally used for quantitative analysis.
Research Objectives
The study focuses on the long-term efficacy of different varicose vein treatment methods. Two objective indicators were selected for the final data synthesis analysis: successful treatment rate (STR) and recurrence rate (RR). STR is defined as anatomical and functional integrity, confirmed by ultrasound as complete ablation, closure, or stripping. RR is defined as the reappearance of any visible varicose veins or pathological reflux after the initial treatment.
Treatment Methods Analysis
The study explored ablation, CHIVA, sclerotherapy, ligation, and stripping, as well as four additional combined treatments (ablation + stripping, ablation + ligation, sclerotherapy + ligation, ligation + stripping). The results showed the success treatment rates as follows: CHIVA > sclerotherapy + ligation > ablation + stripping. Long-term recurrence rates (RR) were: CHIVA < ablation + stripping < stripping.
Discussion
Traditional Surgery
High ligation and stripping (HLS) of the saphenous vein was once considered the “gold standard” for varicose vein surgery. While it can improve quality of life and show efficacy in the short term post-operation, traditional surgery is more traumatic and carries risks of high complication and recurrence rates, potentially failing to maintain long-term clinical benefits. Studies have shown that the recurrence rate of traditional stripping surgery ranges from 20-50%, depending on the experience of the surgeon.