A systematic review and meta-analysis of randomised controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein.
OBJECTIVE
A systematic review and meta-analysis was conducted to compare clinical outcomes between endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS) and surgery.


METHODS
We searched MEDLINE and Scopus from 2000 to August 2011 to identify randomised controlled trials (RCTs) comparing EVLA, RFA, UGFS, and surgery or combinations of these for treatment of varicoses. Differences in clinical outcomes were expressed as pooled risk ratio and unstandardised mean difference for dichotomous and continuous outcomes, respectively. Methodological quality was assessed using Cochrane tools.


RESULTS
Twenty-eight RCTs were included. The primary failure and clinical recurrences were not significantly different between EVLA and RFA versus surgery with the pooled RR of 1.5 (95%CI:0.7, 3.0) and 1.3 (95%CI:0.7, 2.4) respectively for primary failure, and, 0.6 (95%CI:0.3, 1.1) and 0.9 (95%CI:0.6, 1.4) respectively for clinical recurrences. The endovenous techniques had advantages over surgery in lowering wound infections (RR = 0.3 (95%CI:0.1, 0.8) for EVLA), haematoma (RR = 0.5 (95%CI:0.3, 0.8) and 0.4 (95%CI:0.1, 0.8) for EVLA and RFA), and return to normal activities or work (mean differences = -4.9 days (95%CI:-7.1,-2.7) for RFA).


CONCLUSIONS
The primary failure and recurrence in EVLA and RFA were non-significantly different compared with surgery. However, they had lower haematoma, less wound infection, less pain and quicker return to normal activities.
Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
B
B
Siribumrungwong
P
P
Noorit
C
C
Wilasrusmee
J
J
Attia
A
A
Thakkinstian
D055011:Ablation Techniques / Q000009:adverse effects; D000328:Adult; D017115:Catheter Ablation; D057510:Endovascular Procedures / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D015911:Sclerotherapy; D013997:Time Factors; D016896:Treatment Outcome; D014648:Varicose Veins / Q000601:surgery / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000009:adverse effects