Systematic review and meta-analysis of randomized controlled trials evaluating long- term outcomes of endovenous management of lower extremity varicose.

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Presentation transcript:

Systematic review and meta-analysis of randomized controlled trials evaluating long- term outcomes of endovenous management of lower extremity varicose veins Elrasheid A.H. Kheirelseid, PhD, FRCS, Gillian Crowe, MBBS, Rishabh Sehgal, MD, MRCS, Dimitrios Liakopoulos, MD, Hafiz Bela, MD, Edward Mulkern, MD, FRCS, Ciaran McDonnell, MD, FRCS, Martin O’Donohoe, McH, FRCS Journal of Vascular Surgery: Venous and Lymphatic Disorders Volume 6, Issue 2, Pages 256-270 (March 2018) DOI: 10.1016/j.jvsv.2017.10.012 Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 flow diagram. CINAHL, Cumulative Index to Nursing and Allied Health Literature. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 2 Long-term recurrence rate after endovenous laser therapy (EVLT) compared with surgery. Forest plot shows results of meta-analysis of EVLT compared with conventional surgery on varicose vein recurrence. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamond represents the pooled relative risk. M-H, Mantel-Haenszel. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 3 Long-term reintervention rate after endovenous laser therapy (EVLT) compared with surgery. Forest plot shows results of meta-analysis of EVLT compared with conventional surgery on 5-year post-treatment reintervention. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamond represents the pooled relative risk. M-H, Mantel-Haenszel. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 4 Long-term recanalization rate of great saphenous vein (GSV) after endovenous laser therapy (EVLT) compared with surgery. Forest plot shows results of meta-analysis of EVLT compared with conventional surgery on GSV 5-year post-treatment reflux. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamond represents the pooled relative risk. M-H, Mantel-Haenszel. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 5 Long-term risk of neovascularization after endovenous laser therapy (EVLT) compared with surgery. Forest plot shows results of meta-analysis of EVLT compared with conventional surgery on 5-year post-treatment neovascularization. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamond represents the pooled relative risk. M-H, Mantel-Haenszel. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 6 Long-term outcomes of endovenous laser therapy with saphenofemoral junction (SFJ) high ligation (EVLT-HL). Forest plot shows results of meta-analysis of EVLT-HL compared with (A) conventional surgery and (B) endovenous laser therapy (EVLT) without SFJ high ligation looking at (I) varicose vein recurrence, (II) recanalization of great saphenous vein (GSV), and (III) neovascularization. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamonds represent the pooled relative risk. M-H, Mantel-Haenszel; UGFS, ultrasound-guided foam sclerotherapy. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 7 Long-term outcomes of radiofrequency ablation (RFA). Forest plot shows results of meta-analysis of RFA compared with (A) conventional surgery, (B) endovenous laser therapy (EVLT), and (C) ultrasound-guided foam sclerotherapy (UGFS) looking at (I) varicose vein recurrence, (II) recanalization of great saphenous vein (GSV), (III) neovascularization, and (IV) reintervention. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamonds represent the pooled relative risk. M-H, Mantel-Haenszel. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 7 Long-term outcomes of radiofrequency ablation (RFA). Forest plot shows results of meta-analysis of RFA compared with (A) conventional surgery, (B) endovenous laser therapy (EVLT), and (C) ultrasound-guided foam sclerotherapy (UGFS) looking at (I) varicose vein recurrence, (II) recanalization of great saphenous vein (GSV), (III) neovascularization, and (IV) reintervention. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamonds represent the pooled relative risk. M-H, Mantel-Haenszel. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions

Fig 8 Long-term outcomes of ultrasound-guided foam sclerotherapy (UGFS). Forest plot shows results of meta-analysis of UGFS compared with (A) conventional surgery and (B) endovenous laser therapy (EVLT) looking at (I) varicose vein recurrence, (II) recanalization of great saphenous vein (GSV), (III) neovascularization, and (IV) reintervention. The solid squares represent the relative risk, the horizontal lines represent the 95% confidence intervals (CIs), and the diamonds represent the pooled relative risk. M-H, Mantel-Haenszel. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2018 6, 256-270DOI: (10.1016/j.jvsv.2017.10.012) Copyright © 2017 Society for Vascular Surgery Terms and Conditions