الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY rimary varicose vein disease constitutes one of the most frequent inherited disorders worldwide; according to previous epidemiological studies, varicose vein disease affects 10–20% of the population in the Western world and lower prevalence in other parts of the world. Conventional surgical management for varicose veins entails flush ligation of the SFJ, LSV stripping and stab avulsions of the varicosities. Although this surgical modality is safe and effective at short-term and midterm follow-up, it is not rare for recurrence, hematoma, and skin infection to occur after the surgical procedure. Rarely, massive bleeding due to injury to femoral veins, or even to the femoral artery during surgery, and mortality from pulmonary embolism and DVT can happen. Therefore, novel treatment modalities have been developed over recent years to overcome the limitations of conventional surgery. Within the last two decades, radiofrequency ablation and endovenous laser treatment (EVLA) have been introduced as an important new endovenous ablative techniques for the minimally invasive treatment of superficial venous reflux and varicose veins. Therefore, we performed the present systematic review and meta-analysis in order to evaluate the short and long-term outcomes of EVLA compared to conventional surgery. P Summary 93 In the present study, we included 17 reports of 11 eligible RCTs (Total No. of legs =2524). The majority of the included studies were from the UK or Netherlands with sample size ranged between 65 and 798 patients. All included studies recruited patients with great saphenous vein affection, except three studies which included patients with small saphenous vein affection. In the present systematic review and meta-analysis, the average age of the patients ranged from 42-53 years old; while the majority of the patients were females. Overall, our analysis showed that eight RCTs reported the clinical recurrence rates over the period of follow-up, After two years of follow-up, the overall effect estimates favored EVLA over surgery (P =0.04). In contrary, the overall effect estimates did not favor EVLA over surgery at one year (P =0.53) and five years (P =0.12). On the other hand, the present study showed that five RCTs reported the complete success rates over the period of follow-up, After six months of follow-up, the overall effect estimates favored EVLA over surgery (P =0.03). In contrary, the overall effect estimates did not favor EVLA over surgery at other time points. In the present systematic review and metaanalysis, four RCTs reported the change of HVVSS at two years of follow-up. The overall effect estimates did not favor EVLA over surgery (P =0.73). Summary 94 Our analysis showed that, after six months of follow-up, the overall effect estimates did not favor EVLA over surgery. Similarly, the overall effect estimates did not favor EVLA over surgery at one year, two years, and five years. In conclusion, EVLA is a safe and effective treatment alternative for patients with primary varicose veins. The present systematic review and meta-analysis show that EVLA has, at least, comparable efficacy to conventional surgery in terms of recurrence rates, disease severity, and quality of life. Further high-quality long-term studies are still needed to confirm our findings. |