Publication: Interventions for great saphenous vein reflux: Network meta-analysis of randomized clinical trials
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Issued Date
2021-03-01
Resource Type
ISSN
13652168
00071323
00071323
Other identifier(s)
2-s2.0-85106068460
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Mahidol University
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SCOPUS
Bibliographic Citation
British Journal of Surgery. Vol.108, No.3 (2021), 244-255
Suggested Citation
B. Siribumrungwong, C. Wilasrusmee, S. Orrapin, K. Srikuea, T. Benyakorn, G. Mckay, J. Attia, K. Rerkasem, A. Thakkinstian Interventions for great saphenous vein reflux: Network meta-analysis of randomized clinical trials. British Journal of Surgery. Vol.108, No.3 (2021), 244-255. doi:10.1093/bjs/znaa101 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78362
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Title
Interventions for great saphenous vein reflux: Network meta-analysis of randomized clinical trials
Abstract
Background: A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent. Methods: A systematic review and network meta-analysis of RCTs was performed to compare rates of incomplete stripping or non-occlusion of the great saphenous vein with or without reflux (anatomical failure) at early, mid- A nd long-term follow-up; and secondary outcomes (reintervention and clinical recurrence) among intervention groups. The surface under the cumulative ranking curve (SUCRA) method was used to estimate the probability of the intervention with the lowest anatomical failure rates. Results: Some 72 RCTs were included. Comparisons of endothermal techniques with open surgery were mostly not significantly different, except for endovenous laser ablation (EVLA), which had higher long-term anatomical failure rates (pooled risk ratio (RR) 1.87, 95 per cent c.i. 1.14 to 3.07). Mechanochemical ablation had higher anatomical failure rates than radiofrequency ablation (RFA) (pooled RR 2.77, 1.38 to 5.53), and cyanoacrylate closure (CAC) had a RR 0.56 (0.34 to 0.93) times lower than either RFA or EVLA at the early term. Ultrasound-guided foam sclerotherapy had a higher risk of anatomical failure and reintervention than open surgery, with the lowest SUCRA value, and CAC was ranked first, third and first for best intervention for anatomical failure at early, mid and long term respectively. However, clinical recurrence rates were not significantly different between all comparisons. Conclusion: Mechanochemical ablation and ultrasound-guided foam sclerotherapy performed poorly, with higher anatomical failure rates in the long term. The other treatment modalities had similar rates of anatomical failure in the short and mid term.