title: Superficial venous incompetence: low-cost outpatient minisurgery, sclerotherapy and combined procedure as a management plan. Costs and efficacy. A 20-year, follow-up registry.
abstract: BACKGROUND
  This registry study evaluated low-cost outpatient surgery (mini-S) for venous insufficiency as an alternative to stripping.
  
  
  METHODS
  This 20-year follow-up is focused on the recurrence of varices and on the long-term efficacy of the mini-S (group 1) in comparison with controls (2, stripping), sclerotherapy (3) or a combination of mini-S+sclerotherapy (4). Costs were compared.
  
  
  RESULTS
  At 20-years of follow-up, considering recurrence/development of new varicose veins, 24.05% of the limbs treated with mini-S developed new varices in comparison with 64.4% in group 2, 24.1% in group 3 and 15.4% in group 4 (P<0.05). New surgical procedures were needed in 18.9% of mini-S patients vs. 58.5% in group 2, 21.9% in group 3 and 19.7% in group 4 (P<0.05 between group 2 and the other groups). Sclerotherapy (in the years following the initial treatment) was used in 37.9% of mini-S patients in comparison with 67.7% of subjects in group 2 patients, 33.1% in group 3 and 22.8% in group 4 (P<0.05 between outpatient treatment and group 2). The superficial venous system was incompetent in 21% of mini-S patients in comparison with 38.8% in group 2 (P<0.05), 20.7% in group 3 and 17.9% of group 4. At 20 years edema was present in 10.5% of limbs in group 2 in comparison with a <3% (range 2.2-2.1%) in the other groups. Edema was more significant after stripping. Ambulatory venous pressure measurements in subgroups was lower in groups 1, 3 and 4 with a lower refilling time (P<0.05). The cost of in-hospital, daily surgical treatments were €1978 (covered by the heathcare provider). The cost of mini-S was on average €488 per limb (covered by patients).
  
  
  CONCLUSIONS
  Outpatients procedures, in particular the mini-S management plan, were cheaper than stripping and more effective at 20-years follow-up. They could be a model for emerging contries with restricted budgets for vein surgery. Also being cheaper more people may have benefits from treatment when/where hospital procedures are not covered by an healthcare provider.
authors.affiliation: Department of Biomedical Sciences, Irvine3 Circulation/Vascular Labs, PAP/PEA Project, Chieti-Pescara, Italy - cardres@abol.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Belcaro
authors.forename: Mark
authors.initials: M
authors.lastname: Dugall
authors.forename: Marcello
authors.initials: M
authors.lastname: Corsi
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Agus
authors.forename: Edmondo
authors.initials: E
authors.lastname: Ippolito
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008026:Ligation / Q000191:economics; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012008:Recurrence; D012042:Registries; D012501:Saphenous Vein; D015911:Sclerotherapy / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery / Q000628:therapy*