| 1. Spinedi L, Broz P, Peter Engelberger R, Staub D, Uthoff H. Clinical and duplex ultrasound evaluation of lower extremities varicose veins - a practical guideline. [Review]. Vasa. 46(5):325-336, 2017 Aug. |
Review/Other-Dx |
N/A |
To describe the diagnostic work-up of lower extremities varicose veins, based on a careful medical history, physical examination, and duplex ultrasound examination. |
No results stated in abstract. |
4 |
| 2. Winokur RS, Khilnani NM. Superficial veins: treatment options and techniques for saphenous veins, perforators, and tributary veins. [Review]. Tech Vasc Interv Radiol. 17(2):82-9, 2014 Jun. |
Review/Other-Tx |
N/A |
To review the details of anatomy and treatment of the saphenous veins, perforator veins, and tributary veins. |
No results stated in abstract. |
4 |
| 3. Yam BL, Winokur RS, Khilnani NM. Screening for lower extremity venous disease. Clin Imaging 2016;40:325-9. |
Review/Other-Tx |
N/A |
To improve awareness of lower extremity venous disease and encourage screening to identify undiagnosed CVD and to identify patients at earlier stages of disease to prevent progression to more advanced states at the time of initial diagnosis. |
No results available. |
4 |
| 4. Lal BK.. Venous ulcers of the lower extremity: Definition, epidemiology, and economic and social burdens. [Review]. Semin Vasc Surg. 28(1):3-5, 2015 Mar. |
Review/Other-Tx |
N/A |
To discuss the economic and social burdens of those who are affected by venous ulcers. |
No results stated in abstract. |
4 |
| 5. Pannier F, Rabe E. Differential diagnosis of leg ulcers. PHLEBOLOGY. 28 Suppl 1:55-60, 2013 Mar. |
Review/Other-Dx |
N/A |
To demonstrate the differential diagnosis of leg ulcers. |
No results stated in abstract. |
4 |
| 6. Pascarella L, Shortell CK. Medical management of venous ulcers. [Review]. Semin Vasc Surg. 28(1):21-8, 2015 Mar. |
Review/Other-Tx |
N/A |
To discuss the management of care of patients with venous ulcers. |
No results stated in abstract. |
4 |
| 7. Spinedi L, Uthoff H, Partovi S, Staub D. Varicosities of the lower extremity, new approaches: cosmetic or therapeutic needs?. Swiss Med Wkly. 146:w14360, 2016. |
Review/Other-Tx |
N/A |
To provide an overview of the new endovascular vein ablation (EVA) techniques and to elucidate the different therapeutic strategies for varicose veins of the lower extremity (VVLE). |
No results stated in abstract. |
4 |
| 8. Verma H, Tripathi RK. Algorithm-based approach to management of venous leg ulceration. [Review]. Semin Vasc Surg. 28(1):54-60, 2015 Mar. |
Review/Other-Tx |
N.A |
To discuss venous ulcer management with the understanding of the pathophysiology,hemodynamics, venous imaging, and therapeutic options. |
No results stated in abstract. |
4 |
| 9. Arnoldussen CW, de Graaf R, Wittens CH, de Haan MW. Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease. [Review]. PHLEBOLOGY. 28 Suppl 1:169-75, 2013 Mar. |
Review/Other-Dx |
N/A |
To discuss the existing evidence and potential value of computed tomographic venography and magnetic resonance venography to contribute in accurately identifying chronic venous disease, in particular chronic venous obstruction |
No results stated in abstract. |
4 |
| 10. Hua WR, Yi MQ, Jun WX, Xing J, Xuan LZ, Bo L. Causes of recurrent lower limb varicose veins after surgical interventions in 141 limbs - five-year retrospective analysis of two centers. Vascular. 22(4):267-73, 2014 Aug. |
Review/Other-Tx |
112 patients |
To explore the causes of recurrent lower limb varicose veins after surgical interventions. |
The major causes that urged patients to undergo second surgery are clinical changes graded above CEAP IV (93.6%), limb edema without changes on skin (5%), and single varicosity (1.4%). Up to 127 (83%) limbs exhibited perforating venous reflux, 67 (47.5%) limbs had varied degrees of deep venous insufficiency and 68 (48.2%) limbs had through or above-the-knee great saphenous vein trunk residual. |
4 |
| 11. Kim R, Lee W, Park EA, Yoo JY, Chung JW. Anatomic variations of lower extremity venous system in varicose vein patients: demonstration by three-dimensional CT venography. Acta Radiol. 58(5):542-549, 2017 May. |
Review/Other-Dx |
405 patients |
To describe anatomic variations of the lower extremity venous system in patients with varicose veins, using three-dimensional (3D) computed tomographic (CT) venography. |
The most frequent number of tributaries joining the great saphenous vein (GSV) was four (44.4%, 360/810). Only 0.7% (6/810) of the limbs demonstrated unusual location of the GSV between the bifurcated superficial and deep femoral arteries. The most common pattern of veins at the saphenopopliteal junction was a larger caliber of saphenopopliteal junction than thigh extension from small saphenous vein (SSV) (43.8%, 355/810), end of which joining the femoral vein directly (41.0%, 288/703). |
4 |
| 12. Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. [Review][Update of Cochrane Database Syst Rev. 2011;(10):CD005624; PMID: 21975750]. Cochrane Database Syst Rev. (7)CD005624, 2014 Jul 30. |
Review/Other-Tx |
3081 patients |
To determine whether endovenous ablation (radiofrequency and laser) and foam sclerotherapy have any advantages or disadvantages in comparison with open surgical saphenofemoral ligation and stripping of great saphenous vein varices. |
For this update, eight additional studies were included making a total of 13 included studies with a combined total of 3081 randomised patients. Three studies compared ultrasound-guided foam sclerotherapy (UGFS) with surgery, eight compared endovenous laser therapy (EVLT) with surgery and five compared radiofrequency ablation (RFA) with surgery (two studies had two or more comparisons with surgery). Study quality, evaluated through the six domains of risk of bias, was generally moderate for all included studies, however no study blinded participants, researchers and clinicians or outcome assessors. Also, nearly all included studies had other sources of bias. The overall quality of the evidence was moderate due to the variations in the reporting of results, which limited meaningful meta-analyses for the majority of proposed outcome measures. For the comparison UGFS versus surgery, the findings may have indicated no difference in the rate of recurrences in the surgical group when measured by clinicians, and no difference between the groups for symptomatic recurrence (odds ratio (OR) 1.74, 95% confidence interval (CI) 0.97 to 3.12; P = 0.06 and OR 1.28, 95% CI 0.66 to 2.49, respectively). Recanalisation and neovascularisation were only evaluated in a single study. Recanalisation at < 4 months had an OR of 0.66 (95% CI 0.20 to 2.12), recanalisation > 4 months an OR of 5.05 (95% CI 1.67 to 15.28) and for neovascularisation anOR of 0.05 (95%CI 0.00 to 0.94). There was no difference in the rate of technical failure between the two groups (OR 0.44, 95% CI 0.12 to 1.57). For EVLT versus surgery, there were no differences between the treatment groups for either clinician noted or symptomatic recurrence (OR 0.72, 95% CI 0.43 to 1.22; P = 0.22 and OR 0.87, 95% CI 0.47 to 1.62; P = 0.67, respectively). Both early and late recanalisation were no different between the two treatment groups (OR 1.05, 95% CI 0.09 to 12.77; P = 0.97 and OR 4.14, 95% CI 0.76 to 22.65; P = 0.10). Neovascularisation and technical failure were both statistically reduced in the laser treatment group (OR 0.05, 95%CI 0.01 to 0.22; P < 0.0001 and OR 0.29, 95%CI 0.14 to 0.60; P = 0.0009, respectively). Long-term (five-year) outcomes were evaluated in one study so no association could be derived,but it appeared that EVLT and surgery maintained similar findings. Comparing RFA versus surgery, there were no differences in clinician noted recurrence (OR 0.82, 95% CI 0.49 to 1.39; P = 0.47); symptomatic noted recurrence was only evaluated in a single study. There were also no differences between the treatment groups for recanalisation (early or late) (OR 0.68, 95% CI 0.01 to 81.18; P = 0.87 and OR 1.09, 95% CI 0.39 to 3.04; P = 0.87, respectively), neovascularisation (OR 0.31, 95% CI 0.06 to 1.65; P = 0.17) or technical failure (OR 0.82, 95% CI 0.07 to 10.10; P = 0.88). |
4 |
| 13. O'Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. [Review]. J Vasc Surg Venous Lymphat Disord. 4(1):97-105, 2016 Jan. |
Review/Other-Tx |
N/A |
To define the overall incidence of recurrence of varicose veins after surgery (REVAS) as well as both the sites of reflux and the causes of REVAS through a systematic review and meta-analysis of randomized controlled trials (RCTs) for endovenous ablation (EVA). These studies have the advantage of prospectively collected data and a uniform duplex follow-up. |
Of the 68 studies screened, 20 randomized controlled trials (RCTs) that employed endovenous ablation (EVA) of the great saphenous vein (GSV) were identified. Eight had a follow-up of at least 2 years, but one was eliminated because of lack of information on both the site and cause of REVAS. The resultant seven RCTs provided eight comparisons (one study compared both types of EVA to a comparator arm): three used radiofrequency ablation, and five employed endovenous laser ablation. Overall recurrent varicose veins developed in 125 limbs after EVA (22%), with no difference in the incidence vs the ligation and stripping (L&S) group (22%) based on the number of limbs available at the time of the development of recurrence for both groups, but this incidence is dependent on the length of follow-up after the initial treatment. The two studies with serial follow-up showed an approximate doubling of REVAS over time for both EVA and L&S. By contrast, the cause of REVAS was different between the two methods. Neovascularization occurred in only two limbs (2%) after EVA vs 18 (18%) in the L&S group. Recanalization was the most common cause of REVAS for EVA (32%; 40 of 125 limbs), followed by the development of anterior accessory saphenous vein incompetence (19%; 23 of 125 limbs). In contrast to other reports, incompetent calf perforating veins were an infrequent cause of REVAS (7%; eight of 125). |
4 |
| 14. Smith PC.. Management of reticular veins and telangiectases. [Review]. PHLEBOLOGY. 30(2 Suppl):46-52, 2015 Nov. |
Review/Other-Tx |
N/A |
To review the literature related to the management of reticular varices and telangiectases of the lower limbs to provide guidance on the treatment of these veins. |
No results stated in abstract. |
4 |
| 15. Khilnani NM, Meissner MH, Vedanatham S, et al. The evidence supporting treatment of reflux and obstruction in chronic venous disease. J Vasc Surg Venous Lymphat Disord 2017;5:399-412. |
Review/Other-Tx |
N/A |
To present our coalition's consensus review of the literature and recommendations for chronic venous disease |
No results available. |
4 |
| 16. American College of Radiology. ACR–AIUM–SPR–SRU PRACTICE PARAMETER FOR THE PERFORMANCE OF PERIPHERAL VENOUS ULTRASOUND EXAMINATION. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-PeriphVenous.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 17. Shammas NW, Knowles MF, Shammas WJ, et al. Detecting Venous Reflux Using a Sixty-Degree Reverse Trendelenburg (RT-60) Position in Symptomatic Patients With Chronic Venous Disease. J Invasive Cardiol. 28(9):370-2, 2016 Sep. |
Observational-Tx |
33 patients |
To examines the predictability of identifying venous reflux using a reverse Trendelenburg 60° (RT-60) when compared with the standing position (SP) in the great saphenous vein (GSV) and small saphenous vein (SSV). |
A total of 33 patients (56 limbs, 252 segments) were included in this analysis. Mean age was 65 ± 12.4 years and 54.5% were male. All patients were symptomatic (mean clinical, etiology, anatomy, pathophysiology [CEAP] class, 3.5). Deep venous reflux was present in 3/33 patients (9.1%). Of the patients enrolled, 93.9% noted worsening swelling of their lower extremities with standing up and 53.6% of limbs were CEAP class IV or higher. All limbs with no reflux on RT-60 had no reflux using the standing position (SP) and 48/49 limbs (98%) with reflux on SP also had reflux on the RT-60. |
2 |
| 18. Mosti G, Partsch H. High compression pressure over the calf is more effective than graduated compression in enhancing venous pump function. Eur J Vasc Endovasc Surg. 44(3):332-6, 2012 Sep. |
Experimental-Tx |
20 Patients |
To compare the haemodynamic efficiency of a multi-component graduated compression bandage (GCB) versus a negative graduated compression bandage (NGCB) applied with higher pressure over the calf. |
NGCBs with median pressures higher at the calf (62 mmHg) than at the distal leg (50 mmHg) achieved a significantly higher increase of ejection fraction (median +157%) compared with GCB, (+115%) with a distal pressure of 54 mmHg and a calf pressure of 28 mmHg (P < 0.001). |
2 |
| 19. Partsch H, Mortimer P. Compression for leg wounds. [Review]. Br J Dermatol. 173(2):359-69, 2015 Aug. |
Review/Other-Tx |
N/A |
To review the different modes of action of compression therapy in leg ulcers and the tools that are available, including their practical applicability and use for self management. |
No abstract available. |
4 |
| 20. Sundaresan S, Migden MR, Silapunt S. Stasis Dermatitis: Pathophysiology, Evaluation, and Management. [Review]. Am J Clin Dermatol. 18(3):383-390, 2017 Jun. |
Review/Other-Dx |
N/A |
To review the pathophysiology, evaluation, and management of stasis dermatitis. |
No results stated in abstract. |
4 |
| 21. O'Donnell TF, Jr., Passman MA, Marston WA, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery (R) and the American Venous Forum. J Vasc Surg 2014;60:3S-59S. |
Review/Other-Dx |
N/A |
No abstract available |
No abstract available |
4 |
| 22. Fernando RS, Muthu C. Adoption of endovenous laser treatment as the primary treatment modality for varicose veins: the Auckland City Hospital experience. N Z Med J. 127(1399):43-50, 2014 Aug 01. |
Observational-Tx |
354 consecutive EVLT procedures |
To assess the effectiveness of adopting endovenous laser treatment (EVLT) as the primary treatment modality for varicose veins at Auckland City Hospital (Auckland, New Zealand). |
Of the 319 patients who had an ultrasound, at 1 month post-procedure there was a saphenous vein occlusion rate of 96%. Side effects were minimal with no cases of DVT or skin burns and one case of self-limiting neuralgia. The procedure was well tolerated with a median pain score of 3. Since the adoption of EVLT there has been a large increase in the number of patients treated for varicose veins (28 in 2007 compared to 176 in 2013). |
4 |
| 23. Karmacharya RM, Devbhandari M, Shakya YR. Short Term Fate of Great Saphenous Vein after Radiofrequency Ablation for Varicose Veins. Kathmandu Univ. med. j.. 13(51):234-7, 2015 Jul-Sep. |
Observational-Dx |
81 Patients |
To analyze short term fate of segment of great saphenous vein that has been treated by Radiofrequency ablation in terms of occlusion of saphenofemoral junction and absence of recanalisation on Doppler ultrasonography finding done at 3-6 months postoperative period. |
There were total 81 cases with 54.3% female and 45.7% male patients. Mean short term follow up duration was 4.9 months (S.D. 1.1 months). Great Saphenous Vein was cannulated most frequently in between 5 cm above knee to 5 cm below knee. Mean number of Radio Frequency Ablation (RFA) segments were 6.6 (SD=3.1). There was complete occlusion (Type 1 results) in 51 cases (63.0%). In 24 cases (29.6%) there was competent saphenofemoral junction with partial recanalisation in distal part of Great Saphenous Vein (GSV) (Type 2 results). In six cases (7.4%) there was incompetent saphenofemoral junction with partial recanalisation in distal part of Great Saphenous Vein (Type 3 results). There were no cases with incompetent saphenofemoral junction with complete recanalisation in distal part of Great Saphenous Vein (Type 4 results). |
4 |
| 24. Pan Y, Zhao J, Mei J, Shao M, Zhang J. Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis. PHLEBOLOGY. 29(2):109-19, 2014 Mar. |
Meta-analysis |
13 studies |
To evaluate the efficiency and safety of endovenous laser ablation (EVLA) for primary lower extremity varicosities compared with high ligation and stripping (HLS). |
No significant difference in initial technical success rates, Procedural failures were more common following EVLA compared with conventional surgery at one- and two-year follow-up. However, the duplex-detected and clinical recurrence rate was similar between conventional surgery and EVLA after one and two years. No statistical significance was found in postoperative phlebitis and bruise in EVLA and HLS (17.9% versus 21.5%). However, fewer complications were observed in EVLA compared with HLS, including bleeding and haematoma (1.28% versus 4.83%), wound infection (0.33% versus 1.91%) and paraesthesia (6.73% versus 11.27%). |
Inadequate |
| 25. Paravastu SC, Horne M, Dodd PD. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. [Review]. Cochrane Database Syst Rev. 11:CD010878, 2016 11 29. |
Review/Other-Tx |
N/A |
To compare the effectiveness of endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS) versus conventional surgery in the treatment of SSV varices. |
No results stated in the abstract. |
4 |
| 26. Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg. 46(2):308-15, 2007 Aug. |
Observational-Tx |
121 patients (137 legs) |
To describe the short-term results for these variables in a randomized trial comparing endovenous laser (EVL) and high ligation and stripping (HL/S) in patients with varicose veins due to great saphenous vein (GSV) insufficiency. The study was approved by the Regional Ethics Committee. |
A follow-up of 6 months was achieved in 121 patients (137 legs). The groups were well matched for patient and GSV characteristics. Two HL/S procedures failed, and three GSVs recanalized in the EVL group. The groups experienced similar improvement in quality-of-life scores and VCSS score at 3 months. Only one patient in the HL/S group had a major complication, a wound infection that was treated successfully with antibiotics. The HL/S and EVL groups did not differ in mean time to resume normal physical activity (7.7 vs 6.9 calendar days) and work (7.6 vs 7.0 calendar days). Postoperative pain and bruising was higher in the HL/S group, but no difference in the use of analgesics was recorded. The total cost of the procedures, including lost wages, was €3084 ($3948 US) in the HL/S and €3396($4347 US) in the EVL group. |
1 |
| 27. Boersma D, Kornmann VN, van Eekeren RR, et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. [Review]. J Endovasc Ther. 23(1):199-211, 2016 Feb. |
Review/Other-Tx |
49 articles |
To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. |
The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). |
4 |
| 28. Healy DA, Kimura S, Power D, et al. A Systematic Review and Meta-analysis of Thrombotic Events Following Endovenous Thermal Ablation of the Great Saphenous Vein. [Review]. Eur J Vasc Endovasc Surg. 56(3):410-424, 2018 09. |
Meta-analysis |
16,398 patients |
To determine the incidence of thrombotic events following great saphenous vein (GSV) endovenous thermal ablation (EVTA). |
Fifty-two studies (16,398 patients) were included. Thrombotic complications occurred infrequently. Deep venous thrombotic events occurred in 1.7% of cases (95% CI 0.9-2.7%) (25 studies; 10,012 patients; 274 events). EHIT Type 2, 3, or 4 occurred in 1.4% of cases (95% CI 0.8-2.3%) (26 studies; 10,225 patients; 249 events). DVT (deep vein thrombosis) occurred in 0.3% of cases (95% CI = 0.2%-0.5%) (49 studies; 15,676 patients; 48 events). PE (pulmonary embolism) occurred in 0.1% of cases (95% CI = 0.1-0.2%) (29 studies; 8223 patients; 3 events). Similar results were found when the RFA (radiofrequency ablation) and EVLA (endovenous laser ablation) groups were analysed separately. |
Good |
| 29. Gale SS, Lee JN, Walsh ME, Wojnarowski DL, Comerota AJ. A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg. 52(3):645-50, 2010 Sep. |
Observational-Tx |
118 patients |
To evaluate Radiofrequency catheter ablation (RFA) and endovenous laser treatment (EVL) for superficial venous insufficiency due to great saphenous vein (GSV) incompetence and compared early and 1-year results |
The study enrolled 118 patients (141 limbs): 46 (39%) were randomized to RFA and 48 (40%) to EVL, and 24(20%) had bilateral GSV incompetence. At 1 week, one patient in the RFA group had an open GSV and was deemed afailure. More bruising occurred in the EVL group (P = .01) at 1 week, but at 1 month, there was no difference in bruisingbetween groups. At 1 year, DU imaging showed evidence of recanalization with reflux in 11 RFA and 2 EVL patients(P = .002). The mean VCSS score change from baseline to 1 week postprocedure was higher for RFA than EVL (P =.002), but there was no difference between groups at 1 month (P = .07) and 1 year (P = .9). Overall QOL mean scoreimproved over time for all patients (P < .001). CEAP clinical class scores of >3 were recorded in 21 RFA (44%) and 24EVL patients (44%) pretreatment, but at 1-year, 9 RFA (19%) and 12 EVL patients (24%) had scores of >3 (P < .001).This represented a significant improvement in all patients compared with baseline. |
1 |
| 30. Kheirelseid EAH, Crowe G, Sehgal R, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. [Review]. Journal of Vascular Surgery. 6(2):256-270, 2018 03. |
Meta-analysis |
9 RCTs |
To determine long-term efficacy of currently available endovenous therapy methods for varicose veins compared with conventional surgery (saphenofemoral ligation and stripping of great saphenous vein [GSV] with or without multiple avulsions) in management of GSV-related varicose veins. |
At time of data extraction, long-term follow-up was available for endovenous laser therapy (EVLT), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy. Included in the review were nine RCTs. The RCTs included 2185 legs; however, only 1352 legs were followed up for 5 years (61.9%). There was no statically significant difference in recurrence rate in comparing EVLT with conventional surgery in treating GSV incompetence (36.6% vs 33.3%, respectively; pooled risk ratio, 1.35; 95% confidence interval, 0.76-2.37; P = .3). Also, no statistically significant difference was determined for recurrence rate in comparing RFA with surgery or EVLT. |
Good |
| 31. He G, Zheng C, Yu MA, Zhang H. Comparison of ultrasound-guided endovenous laser ablation and radiofrequency for the varicose veins treatment: An updated meta-analysis. International Journal Of Surgery. 39:267-275, 2017 Mar. |
Meta-analysis |
1,577 patients |
To investigate and compare the relative efficacy, recurrence and complications of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) for the treatment of varicose veins patients. |
12 reported studies with a combined total of 1577 patients were included. vein ablated length (SMD: 0.37, 95% CI: 0.04 to 0.77), 3 days pain scores (SMD: 11.25, 95% CI: 3.42 to 25.92) and 10 days (SMD:0.79, 95% CI: 0.48 to 2.05),1 month quality of Life (SMD: 0.09, 95% CI: 0.28 to 0.10) and 1 year (SMD: 0.04, 95% CI: 0.21 to 0.13), occlusion (OR: 1.05, 95% CI: 0.41 to 2.73), thrombophlebitis (RR: 1.03, 95% CI: 0.56 to 1.92), haematoma (OR: 1.55, 95% CI: 0.54 to 4.45) and recanalization (OR: 0.68, 95% CI: 0.43 to 1.09) following RFA showed no difference when compared with EVLA. These results were not statistically significant. RFA was associated with the lower overall complication (OR: 3.49, 95% CI: 1.36 to 8.96) in patients with varicose veins compared to the EVLA treatment. |
Good |
| 32. Vos CG, Unlu C, Bosma J, van Vlijmen CJ, de Nie AJ, Schreve MA. A systematic review and meta-analysis of two novel techniques of nonthermal endovenous ablation of the great saphenous vein. [Review]. Journal of Vascular Surgery. 5(6):880-896, 2017 11. |
Meta-analysis |
15 studies |
To evaluate the efficacy of mechanochemical endovenous ablation (MOCA) and cyanoacrylate vein ablation (CAVA) for GSV incompetence. |
Fifteen articles met the inclusion criteria. Pooled anatomic success for MOCA and CAVA was 94.7% and 94.8% at 6 months and 94.1% and 89.0% at 1 year, respectively. Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire score significantly improved after treatment with MOCA and CAVA. |
Good |
| 33. Biemans AA, Kockaert M, Akkersdijk GP, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 58(3):727-34.e1, 2013 Sep. |
Observational-Tx |
240 patients |
To compare the anatomic success rate, frequency of major complications, and quality-of-life improvement of endovenous laser ablation (EVLA), ultrasound-guided foam sclerotherapy (UGFS), and conventional surgery (CS), after 1-year follow-up. |
More than 80% of the study population was classified as C2 or C3 venous disease. After 1 year, the anatomic success rate was highest after EVLA (88.5%), followed by CS (88.2%) and UGFS (72.2%) (P < .001). The complication rate was low and comparable between treatment groups. All groups showed significant (P < .001) improvement of EuroQol 5 and Chronic Venous Insufficiency Quality-of-Life Questionnaire scores after therapy; 84.3% of all treated patients showed an improvement of the “C” of the CEAP classification. |
1 |
| 34. Lam YL, Lawson JA, Toonder IM, et al. Eight-year follow-up of a randomized clinical trial comparing ultrasound-guided foam sclerotherapy with surgical stripping of the great saphenous vein. Br J Surg. 105(6):692-698, 2018 05. |
Observational-Tx |
430 patients |
To compare ultrasound-guided foam sclerotherapy (UGFS) with high ligation and surgical stripping (HL/S) of the great saphenous vein (GSV). |
Of 430 patients originally randomized (230 UGFS, 200 HL/S), 227 (52.8 per cent; 123 UGFS, 103 HL/S) were available for analysis after 8 years. The proportion of patients free from symptomatic GSV reflux at 8 years was lower after UGFS than HL/S (55.1 versus 72.1 per cent; P = 0.024). The rate of absence of GSV reflux, irrespective of venous symptoms, at 8 years was 33.1 and 49.7 per cent respectively (P = 0.009). More saphenofemoral junction (SFJ) failure (65.8 versus 41.7 per cent; P = 0.001) and recurrent reflux in the above-knee GSV (72.5 versus 20.4 per cent; P = 0.001) was evident in the UGFS group. The VCSS was worse than preoperative scores in both groups after 8 years; CEAP classification and EQ-5D(R) scores were similar in the two groups. |
1 |
| 35. van der Velden SK, Biemans AA, De Maeseneer MG, et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 102(10):1184-94, 2015 Sep. |
Observational-Tx |
224 legs |
To determine the long-term outcomes of treatment for patients with great saphenous vein (GSV) viscosities. |
A total of 224 legs were included (69 conventional surgery, 78 EVLA, 77 UGFS), 193 (86.2 per cent) of which were evaluated at final follow-up. At 5 years, Kaplan-Meier estimates of obliteration or absence of the GSV were 85 (95 per cent c.i. 75 to 92), 77 (66 to 86) and 23 (14 to 33) per cent in the conventional surgery, EVLA and UGFS groups respectively. Absence of above-knee GSV reflux was found in 85 (73 to 92), 82 (72 to 90) and 41 (30 to 53) per cent respectively. CIVIQ scores deteriorated over time in patients in the UGFS group (0.98 increase per year, 95 per cent c.i. 0.16 to 1.79), and were significantly worse than those in the EVLA group (-0.44 decrease per year, 95 per cent c.i. -1.22 to 0.35) (P = 0.013). CIVIQ scores for the conventional surgery group did not differ from those in the EVLA and UGFS groups (0.44 increase per year, 95 per cent c.i. -0.41 to 1.29). EQ-5D scores improved equally in all groups. |
1 |
| 36. Venermo M, Saarinen J, Eskelinen E, et al. Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins. Br J Surg. 103(11):1438-44, 2016 Oct. |
Experimental-Tx |
214 patients |
To compare the effect of surgery, endovenous laser ablation (EVLA) (with phlebectomies) and UGFS on quality of life and the occlusion rate of the great saphenous vein (GSV) 12 months after surgery. |
The study included 214 patients: 65 had surgery, 73 had EVLA and 76 had UGFS. At 1 year, the GSV was occluded or absent in 59 (97 per cent) of 61 patients after surgery, 71 (97 per cent) of 73 after EVLA and 37 (51 per cent) of 72 after UGFS (P < 0.001). The AVVSS improved significantly in comparison with preoperative values in all groups, with no significant differences between them. Perioperative pain was significantly reduced and sick leave shorter after UGFS (mean 1 day) than after EVLA (8 days) and surgery (12 days). |
1 |
| 37. Christenson JT, Gueddi S, Gemayel G, Bounameaux H. Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up. J Vasc Surg. 52(5):1234-41, 2010 Nov. |
Observational-Tx |
204 limbs |
To compare EVLT (980 nm) and HL/S results at 1 and 2 years after the intervention. |
There were no differences in patient demographics, CEAP class, Widmer class, or severity scores between the groups. Simultaneous interventions did not differ between the groups. Similar times for the return to normal activity and scores for postoperative pain were reported. No major complications after treatment were recorded. HL/S limbs had significantly more postoperative hematomas than EVLT limbs, and EVLT patients reported more bruising. Follow-up at 1 year was 100% for HL/S and 99% for EVLT. Two GSVs in the EVLT group reopened and three partially reopened. No open GSVs occurred in HL/S limbs. Ninety-eight percent of the limbs in both groups were free of symptoms. VCSS, AVVSS, and Short Form-36 scores did not reveal any group differences. At 2 years, no differences compared with 1-year results were observed, except that two more GSVs in the EVLT group were partially reopened. |
1 |
| 38. Rass K, Frings N, Glowacki P, Graber S, Tilgen W, Vogt T. Same Site Recurrence is More Frequent After Endovenous Laser Ablation Compared with High Ligation and Stripping of the Great Saphenous Vein: 5 year Results of a Randomized Clinical Trial (RELACS Study). Eur J Vasc Endovasc Surg. 50(5):648-56, 2015 Nov. |
Observational-Tx |
281 legs |
To compare the long-term clinical efficacy of endovenous laser ablation (EVLA) with high ligation and stripping (HLS) as standard treatment for great saphenous vein (GSV) incompetence. |
Two hundred and eighty one legs (81% of the study population) were evaluated with a median follow up of 60.4 (EVLA) and 60.7 months (HLS). Overall, REVAS was similarly observed in both groups: 45% (EVLA) and 54% (HLS), p = .152. Patients of the EVLA group showed significantly more clinical recurrences in the operated region (REVAS: same site): 18% vs. 5%, p = .002. In contrast, more different site recurrences were observed in the HLS group: 50% vs. 31%, p = .002. Duplex detected saphenofemoral refluxes occurred more frequently after EVLA: 28% vs. 5%, p < .001. Both treatments improved disease severity and quality of life without any difference. |
1 |
| 39. Rass K, Frings N, Glowacki P, et al. Comparable effectiveness of endovenous laser ablation and high ligation with stripping of the great saphenous vein: two-year results of a randomized clinical trial (RELACS study). Arch Dermatol. 148(1):49-58, 2012 Jan. |
Observational-Tx |
400 patients |
To compare the clinical efficacy and safety of endovenous laser treatment (EVLT) with high ligation and stripping (HLS) as standard treatment for great saphenous vein (GSV) insufficiency. |
Clinically recurrent varicose veins after surgery were similarly observed in both groups: 16.2% (EVLT treated group) vs 23.1% (HLS-treated group); P=.15. Duplex-detected saphenofemoral refluxes occurred significantly more frequently after EVLT (17.8% vs 1.3%; P=.001). Both treatments equally improved medical condition (Homburg Varicose Vein Severity Score) and diseaserelated quality of life. Endovenous laser treatment caused more adverse effects (phlebitic reaction, tightness, dyspigmentation) but revealed advantages concerning hemodynamics, recovery, and cosmetic outcome. |
1 |
| 40. Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg 2013;58:421-6. |
Experimental-Tx |
surgery = 59 patients (68 legs), EVLA = 62 patients (69 legs) |
To describe the outcome with regard to clinical and ultrasound recurrence, number of reoperations, Venous Clinical Severity Score (VCSS), and QOL. |
In the EVLA and stripping group, nine (Kaplan-Meier [KM] estimate, 17.9%) and four (KM estimate, 10.1%) of GSVs had open refluxing segments of 5 cm or more (ns). Clinical recurrence was recorded in 24 (KM estimate, 46.6%) and 25 (KM estimate, 54.6%), whereas reoperations were performed in 17 (KM estimate, 38.6%) and 15 (KM estimate, 37.7%) legs (ns). Venous Clinical Severity Score and Aberdeen Varicose Vein Symptoms Severity Score improved whereas Medical Outcomes Study Short Form-36 quality of life score improved in several domains in both groups with no difference between the groups. |
1 |
| 41. Gagne PJ, Tahara RW, Fastabend CP, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord. 5(5):678-687, 2017 09. |
Observational-Dx |
100 patients |
To compare the diagnostic efficacy of intravascular ultrasound (IVUS) with multiplanar venography for iliofemoral vein obstruction. |
Venography identified stenotic lesions in 51 of 100 subjects, whereas IVUS identified lesions in 81 of 100 subjects. Compared with IVUS, the diameter reduction was on average 11% less for venography (P < .001). The intraclass correlation coefficient was 0.505 for vein diameter stenosis calculated with the two methods. IVUS identified significant lesions not detected with three-view venography in 26.3% of patients. Investigators revised the treatment plan in 57 of 100 cases after IVUS, most often because of failure of venography to detect a significant lesion (41/57 [72%]). IVUS led to an increased number of stents in 13 of 57 subjects (23%) and the avoidance of an endovascular procedure in 3 of 57 subjects (5%). Overall, IVUS imaging changed the treatment plan in 57 patients; 54 patients had stents placed on the basis of IVUS detection of significant iliofemoral vein obstructive lesions not appreciated with venography, whereas 3 patients with significant lesions on venography had no stent placed on the basis of IVUS. |
3 |
| 42. Gagne PJ, Gasparis A, Black S, et al. Analysis of threshold stenosis by multiplanar venogram and intravascular ultrasound examination for predicting clinical improvement after iliofemoral vein stenting in the VIDIO trial. J Vasc Surg Venous Lymphat Disord. 6(1):48-56.e1, 2018 01. |
Observational-Dx |
100 patients |
To compare the diagnostic efficacy of intravascular ultrasound (IVUS) with multiplanar venography for iliofemoral vein obstruction. |
Clinical improvement after stenting was best predicted by IVUS baseline measurement of area stenosis (area under the curve, 0.64; P = .04), with >54% estimated as the optimal threshold of stenosis indicating interventional treatment. With measurement of lumen gain from baseline to after the procedure, the optimal reduction in vein stenosis correlative of later clinical improvement was >41%; IVUS measurement of area stenosis was most predictive (area under the curve, 0.70; P = .004). Venographic measurements of baseline stenosis and stenotic change were not predictive of later improvement. In a 48-patient nonthrombotic subset analysis, IVUS diameter rather than area measurements of baseline stenosis were significantly predictive of clinical success, but indicated a higher optimal threshold of stenosis (>61%) may be necessary. |
3 |
| 43. Humphreys ML, Stewart AH, Gohel MS, Taylor M, Whyman MR, Poskitt KR. Management of mixed arterial and venous leg ulcers. Br J Surg. 94(9):1104-7, 2007 Sep. |
Observational-Tx |
1378 Patients |
To assess healing in patients with mixed arterial and venous leg ulcers after protocol-driven treatment in a specialist leg ulcer clinic. |
Of 2011 ulcerated legs, 1416 (70.4 per cent) had venous reflux. Of these 1416, 193 (13.6 per cent) had moderate and 31 (2.2 per cent) had severe arterial disease. Healing rates by 36 weeks were 87, 68 and 53 per cent for legs with insignificant, moderate and severe arterial disease respectively (P < 0.001). Seventeen legs with moderate and 15 with severe arterial disease were revascularized. Of these, ulcers healed in four legs with moderate and seven with severe disease within 36 weeks of revascularization (P = 0.270). Combined 30-day mortality for revascularization was 6.5 per cent. |
3 |
| 44. Raju S, Kirk O, Davis M, Olivier J. Hemodynamics of "critical" venous stenosis and stent treatment. J Vasc Surg Venous Lymphat Disord 2014;2:52-9. |
Review/Other-Tx |
96 preoperative patients, 551 postoperative patients |
To clarify the many variables that determine “criticality” of iliac vein stenoses using a mechanical venous model. To confirm that pressure-related parameters improve after stenting as suggested by model results. |
The mechanical model showed that upstream pressure varied based on (1) volume of venous inflow, (2) abdominal pressure, (3) outflow pressure, and (4) outflow stenosis. Upstream pressure changes were inverse to flow as kinetic energy was converted to pressure as required. A venous stenosis of as little as 10% raised upstream pressure in the model when the abdominal pressure was low, but high grades of stenosis had no contribution when abdominal pressure was high. Stenting of the Penrose moderated or nullified upstream pressure changes related to abdominal pressure. There was significant decompression of the common femoral vein, implying pressure reduction after stenting; median area reduction was 15% and 10% in erect and supine, respectively. Air plethysmography showed improvement in venous volume and in other parameters in confirmation of venous decompression. There was significant prolongation of phasic flow duration and quantitative phasic flow increased (median, 16%) after stenting in the erect position. There was no increase in arterial inflow. |
4 |
| 45. Labropoulos N, Borge M, Pierce K, Pappas PJ. Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg 2007;46:101-7. |
Observational-Tx |
37 patients |
To determine criteria for a clinically significant vein stenosis with duplex ultrasound (DU) in patients with signs and symptoms of central venous outflow obstruction. |
Thirty-seven patients, 20 males and 17 females, mean age 54 years, range 27 to 79, were evaluated. Forty-one stenotic venous sites were detected with DU; inferior vena cava 14, superior vena cava 2, portal 2, iliac 11, common femoral 3, brachiocephalic 3, subclavian 5, and axillary vein 1. Phlebography identified 37 of these stenoses and demonstrated two more not seen by DU. Pressure measurements confirmed 39 of those detected by DU. The best criterion by DU to detect a >50% stenosis was a poststenotic to pre-stenotic peak vein velocity ratio of 2.5. The presence of poststenotic turbulence and planimetric calculations of the diameter reduction increased the diagnostic confidence but not the accuracy. Using the pressure gradient of >/=3 mm Hg as a reference test, there were two false positive and two false negative exams with DU, while phlebography had two false negative exams. The overall agreement of DU alone was 90% of phlebography >95% and when combined 100%. Intravascular ultrasound identified correctly all 11 lesions in 11 patients. After angioplasty and stenting, there was a dramatic reduction in the edema in most patients particularly in those that had a caval stenosis. Restenosis was identified by DU in 5/29 (17%) patients at 6 months that were confirmed by phlebography and pressure measurements. Reintervention was performed in four and it was successful in three. |
2 |
| 46. Metzger PB, Rossi FH, Kambara AM, et al. Criteria for detecting significant chronic iliac venous obstructions with duplex ultrasound. J Vasc Surg Venous Lymphat Disord 2016;4:18-27. |
Observational-Dx |
15 patients (30 limbs) in Group 1, 51 patients (102 limbs) in Group 2 |
To determine the sonographic criteria for diagnosis of iliac venous outflow obstruction by assessing the correlation of this method with intravascular ultrasound (IVUS) in patients with advanced chronic venous insufficiency (CVI). |
The predominant clinical severity CEAP class was C1 in 24 of 30 limbs (80%) in GI and C3 in 54 of 102 limbs (52.9%) in GII. Reflux was severe (reflux multisegment score =3) in 3 of 30 limbs (10%) in GI and in 45 of 102 limbs (44.1%) in GII (P < .001). There was a moderately high agreement between DU and IVUS findings when they were grouped into three categories (? = 0.598; P < .001) and high agreement when they were grouped into two categories (obstructions <50% and =50%; ? = 0.784; P < .001). The best cutoff points and their correlation with IVUS were 0.9 for the velocity index (r = -0.634; P < .001), 0.7 for the flow index (r = -0.623; P < .001), 0.5 for the obstruction ratio (r = 0.750; P < .001), and 2.5 for the velocity ratio (r = 0.790; P < .001). Absence of flow phasicity was observed in 62.5% of patients with obstructions =80%. An ultrasound algorithm was created using the measures and the described cutoff points with accuracy of 86.7% for detecting significant obstructions (=50%) with high agreement (? = 0.73; P < .001). |
1 |
| 47. Lurie F, Lal BK, Antignani PL, et al. Compression therapy after invasive treatment of superficial veins of the lower extremities: Clinical practice guidelines of the American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology. J Vasc Surg Venous Lymphat Disord 2019;7:17-28. |
Review/Other-Tx |
N/A |
To review available evidence and to recommend practice guidelines. |
N/A |
4 |
| 48. Gohel MS, Heatley F, Liu X, et al. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. N Engl J Med 2018;378:2105-14. |
Experimental-Tx |
244 patients (early intervention
group), 226 patients (deferred intervention
group) |
To evaluate the role of early endovenous treatment of superficial venous reflux as an adjunct to compression therapy in patients with venous leg ulcers. |
Patient and clinical characteristics at baseline were similar in the two treatment groups. The time to ulcer healing was shorter in the early-intervention group than in the deferred-intervention group; more patients had healed ulcers with early intervention (hazard ratio for ulcer healing, 1.38; 95% confidence interval [CI], 1.13 to 1.68; P = 0.001). The median time to ulcer healing was 56 days (95% CI, 49 to 66) in the early-intervention group and 82 days (95% CI, 69 to 92) in the deferred intervention group. The rate of ulcer healing at 24 weeks was 85.6% in the early-intervention group and 76.3% in the deferred-intervention group. The median ulcer-free time during the first year after trial enrollment was 306 days (interquartile range, 240 to 328) in the early-intervention group and 278 days (interquartile range, 175 to 324) in the deferred intervention group (P = 0.002). The most common procedural complications of endovenous ablation were pain and deep-vein thrombosis. |
1 |
| 49. Rossi FH, Kambara AM, Izukawa NM, et al. Randomized double-blinded study comparing medical treatment versus iliac vein stenting in chronic venous disease. J Vasc Surg Venous Lymphat Disord. 6(2):183-191, 2018 03. |
Experimental-Tx |
26 patients (stent group); 25 patients (BMT group) |
To compare medical and endovascular treatment results in symptomatic chronic venous disease (CVD) patients with significant IVO documented by intravascular ultrasound (IVUS). |
Of 207 CVD patients, 58 (28%) were eligible and eight (14%) were excluded; 51 of 85 class C3 to C6 limbs (60%) had =50% IVO by IVUS. Iliac vein stenting, in randomized patients, was 100% technically successful. At 6 months' follow-up, the mean VAS pain score declined from a median of 8 to 2.5 in patients receiving stents and from 8 to 7 in patients receiving only medical treatment (P < .001). The Venous Clinical Severity Score dropped from a median of 18.5 to 11 after stenting and from 15 to 14 with medical treatment (P < .001). The 36-Item Short Form Health Survey (0-100) improved from a total median score of 53.9 to 85.0 with stenting and 48.3 to 59.8 after medical treatment (P < .001). There was no stent fracture or migration, and the primary, assisted primary, and secondary patency rates were 92%, 96%, and 100%, respectively (median, 11.8; range, 6-18 months). |
1 |
| 50. Meissner MH, Khilnani NM, Labropoulos N, et al. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Journal of Vascular Surgery. 9(3):568-584, 2021 05.J Vasc Surg Venous Lymphat Disord. 9(3):568-584, 2021 05. |
Review/Other-Tx |
N/A |
To develop a classification of pelvic venous disorders (PeVD) which accurately defines the diverse patient populations with PeVD. |
Based on a perceived need, the American Vein and Lymphatic Society convened an international, multidisciplinary panel charged with the development of a discriminative classification instrument for PeVD. This instrument, the Symptoms-Varices-Pathophysiology ("SVP") classification for PeVD, includes three domains-Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease. An individual patient's classification is designated as SVPA,H,E. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with the Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. |
4 |
| 51. Bora A, Avcu S, Arslan H, Adali E, Bulut MD. The relation between pelvic varicose veins and lower extremity venous insufficiency in women with chronic pelvic pain. JBR-BTR. 95(4):215-21, 2012 Jul-Aug. |
Observational-Dx |
1029 Women |
To determine the relation between pelvic varicose veins and lower extremity venous insufficiency in women with chronic pelvic pain. |
Pelvic varicose veins were discovered with transabdominal ultrasound and computerized tomography in 56 of 1029 patients. Various degrees of associated lower extremity venous insufficiency were also discovered in 44 of 56 patients (78,6%) with pelvic venous dilatation. Of the 44 patients with lower extremity venous insufficiency, 21 were bilateral, 9 were right-sided, and 14 were left-sided. Endometrial thickness was significantly increased in patients with pelvic venous dilatation. |
4 |
| 52. Khilnani NM, Meissner MH, Learman LA, et al. Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2019;30:781-89. |
Review/Other-Dx |
N/A |
To convene a multidisciplinary group of experts to review the current Pelvic Venous Disorder literature and develop a prioritized research agenda to address identified evidence gaps. |
No results available. |
4 |
| 53. Labropoulos N, Jasinski PT, Adrahtas D, Gasparis AP, Meissner MH. A standardized ultrasound approach to pelvic congestion syndrome. [Review]. Phlebology. 32(9):608-619, 2017 Oct.PHLEBOLOGY. 32(9):608-619, 2017 Oct. |
Review/Other-Tx |
N/A |
To discuss selective ovarian venography, an invasive imaging approach, which is believed to be the gold standard for diagnosing pelvic congestion syndrome. |
N/A |
4 |
| 54. Knuttinen MG, Xie K, Jani A, Palumbo A, Carrillo T, Mar W. Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues. AJR Am J Roentgenol 2015;204:448-58. |
Review/Other-Tx |
N/A |
To review the causes of pelvic congestion syndrome and the imaging used to make the diagnosis and to summarize the treatment options. |
No results available. |
4 |
| 55. Hansrani V, Dhorat Z, McCollum CN. Diagnosing of pelvic vein incompetence using minimally invasive ultrasound techniques. Vascular. 25(3):253-259, 2017 Jun.Vascular. 25(3):253-259, 2017 Jun. |
Observational-Tx |
50 females patients |
To establish the best method of reproducing pelvic vein incompetence (PVI) using trans-vaginal ultrasound (TVU) and to formulate a standardised protocol that can be universally used and compared with the current gold standard. To assess the level of diagnostic readability and inter-observer reproducibility of TVU for PVI detection. |
Mean (range) age of 43 (23–51). Visibility of all four pelvic veins was better in the supine position compared with semi-standing position (76% vs 64%). Pelvic vein incompetence was identified in 34 of 50 (68%) women in the supine position compared with 38 of 50 (76%) women in the semi-standing position. Pelvic vein incompetence was demonstrated in 35 of 50 (70%) women with Valsalva manoeuvre. Inter-observer variability was 0.84 (kappa, very good agreement, p=0.001). |
2 |
| 56. Lopez AJ. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes. Cardiovasc Intervent Radiol 2015;38:806-20. |
Review/Other-Tx |
N/A |
To describe the indications, techniques, and outcomes of treating pelvic venous congestion syndrome (PVC) with pelvic vein embolization (PVE) in females. |
No results provided. |
4 |
| 57. Borghi C, Dell'Atti L. Pelvic congestion syndrome: the current state of the literature. [Review]. Arch Gynecol Obstet. 293(2):291-301, 2016 Feb. |
Review/Other-Dx |
N/A |
To explore the pathophysiology, clinical features, diagnostic investigations, and treatment option of pelvic congestion syndrome which affects young women with considerable implications for their daily social and psychological condition. |
Pelvic pain and venous varices are often both present in premenopausal women, but not necessarily causally related. Furthermore, incompetent and dilated pelvic veins are a common finding in asymptomatic women. As such, it is challenging but important to determine which patients have chronic pelvic pain specifically related to pelvic congestion syndrome in order to treat them properly. |
4 |
| 58. Gandini R, Konda D, Abrignani S, et al. Treatment of symptomatic high-flow female varicoceles with stop-flow foam sclerotherapy. Cardiovasc Intervent Radiol. 37(5):1259-67, 2014 Oct. |
Observational-Tx |
26 Patients |
To assess the efficacy of stop-flow foam sclerotherapy (SFFS) in high-flow pelvic varicoceles using 3 % sodium tetradecyl sulfate (STS) foam. |
The procedure was technically successful in all patients. After the injection of 3 % STS foam, all patients had a colic like pain that spontaneously resolved after 5 min. During follow-up, no recurrences of PCS were detected. Significant improvement of symptoms (Student's t test P < 0.01) was observed at 1, 3, 6, and 12 months. |
2 |
| 59. Daniels JP, Champaneria R, Shah L, Gupta JK, Birch J, Moss JG. Effectiveness of Embolization or Sclerotherapy of Pelvic Veins for Reducing Chronic Pelvic Pain: A Systematic Review. [Review]. J Vasc Interv Radiol. 27(10):1478-1486.e8, 2016 Oct. |
Review/Other-Dx |
N/A |
To systematically and critically review the effectiveness of embolization of incompetent pelvic veins. |
Twenty-one prospective case series and one poor-quality randomized trial of embolization (involving a total of 1,308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, and generally increased over time and was sustained. Significant pain reductions following treatment were observed in all studies that measured pain on a visual analog scale. Repeat intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve, or fertility, but no concerns were noted. Transient pain was common following foam embolization, and there was a < 2% risk of coil migration. |
4 |
| 60. Rabe E, Pannier F. Embolization is not essential in the treatment of leg varices due to pelvic venous insufficiency. [Review]. PHLEBOLOGY. 30(1 Suppl):86-8, 2015 Mar. |
Review/Other-Dx |
N/A |
To consider if it is essential to perform embolization in the treatment of leg varices due to pelvic venous insufficiency. |
Pelvic venous insufficiency, vulvar and pudendal varicose veins as well as pelvic congestive syndrome are under diagnosed entities. Embolization of ovarian and pelvic veins is well established in patients with pelvic congestive syndrome. In varicose veins of pelvic origin but without pelvic congestive syndrome, comparative studies comparing the outcome of embolization or treatment of varicose veins by sclerotherapy or phlebectomy alone are missing. Foam sclerotherapy or phlebectomy shows good results in patients with varicose veins of pelvic origin. |
4 |
| 61. Koo S, Fan CM. Pelvic congestion syndrome and pelvic varicosities. [Review]. Tech Vasc Interv Radiol. 17(2):90-5, 2014 Jun. |
Review/Other-Dx |
N/A |
To review the pelvic retroperitoneal venous anatomy, pathophysiology of pelvic congestion syndrome (PCS), treatment options and techniques, and clinical outcomes of embolotherapy for PCS. |
No results stated in abstract. |
4 |
| 62. Kies DD, Kim HS. Pelvic congestion syndrome: a review of current diagnostic and minimally invasive treatment modalities. [Review]. PHLEBOLOGY. 27 Suppl 1:52-7, 2012 Mar. |
Review/Other-Dx |
N/A |
To review current diagnostic and minimally invasive treatment modalities for pelvic congestion syndrome. |
No results stated in abstract. |
4 |
| 63. O'Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. [Review]. J Vasc Surg Venous Lymphat Disord. 3(1):96-106, 2015 Jan. |
Review/Other-Dx |
N/A |
To review the literature to investigate the current state of the diagnosis and treatment of pelvic congestion syndrome. |
No results stated in abstract. |
4 |
| 64. Rundqvist E, Sandholm LE, Larsson G. Treatment of pelvic varicosities causing lower abdominal pain with extraperitoneal resection of the left ovarian vein. Ann Chir Gynaecol. 73(6):339-41, 1984. |
Review/Other-Dx |
15 Women |
To present eight years experience with extraperitoneal resection of the left ovarian vein in women with chronic lower abdominal pain, where careful preoperative investigation failed to demonstrate any other cause than the pelvic varicosities. |
Fifteen women with chronic pelvic pain in whom left sided renal phlebography had demonstrated pelvic varicosities were operated upon with extraperitoneal resection of the left ovarian vein during an eight year period. At follow-up eight patients were completely cured and three were considerably improved, but in four women no improvement occurred. Mean period of follow-up was 5.6 years (range 0.5 to 8 years). All but two women were followed for at least three years. The complication rate was low. One case of wound infection and one case with bleeding from a subcutaneous artery necessitating resuture were the only complications. |
4 |
| 65. Gargiulo T, Mais V, Brokaj L, Cossu E, Melis GB. Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome. J Am Assoc Gynecol Laparosc. 10(4):501-4, 2003 Nov. |
Review/Other-Tx |
23 Women |
To evaluate the efficacy and safety of bilateral laparoscopic transperitoneal ligation of the ovarian veins in women with symptomatic pelvic varices. |
After the plateau of the learning curve was reached, average operating time was about 60 minutes without complications. Complete remission of pain and absence of pelvic varicosities lasted for 12 months. |
4 |
| 66. Smith PC.. The outcome of treatment for pelvic congestion syndrome. [Review]. PHLEBOLOGY. 27 Suppl 1:74-7, 2012 Mar. |
Review/Other-Tx |
N/A |
To review the outcomes of treatments for pelvic congestion syndrome. |
No results stated in abstract. |
4 |
| 67. Mahmoud O, Vikatmaa P, Aho P, et al. Efficacy of endovascular treatment for pelvic congestion syndrome. [Review]. J Vasc Surg Venous Lymphat Disord. 4(3):355-70, 2016 07. |
Review/Other-Tx |
N/A |
To provide a brief overview of the anatomy, pathophysiology, and clinical aspects of ovarian and pelvic varices. We describe the technique of transcatheter embolization, the complications thereof and the clinical results of the treatment. |
Twenty studies with a total of 1081 patients were included in the review. There were no randomized trials, and only one study included a control group. The immediate technical success rate in the occlusion of the affected veins was 99%. Seventeen studies reported the 1- to 3-month clinical success of 641 patients. Of these, 88.1% reported moderate to significant relief in the symptoms and 11.9% reported little or no relief. In 17 studies, long-term results were reported, and the follow-up varied between 7.3 months and 5 years. In late follow-up, 86.6% reported relief of the symptoms and 13.6% experienced little or no relief. |
4 |
| 68. Dorobisz TA, Garcarek JS, Kurcz J, et al. Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences. Advances in Clinical & Experimental Medicine. 26(2):269-276, 2017 Mar-Apr.Adv. Clin. Exp. Med.. 26(2):269-276, 2017 Mar-Apr. |
Observational-Tx |
10 Women |
To evaluate the efficacy of ovarian vein embolization ovarian as a method of the pelvic congestion syndrome (PCS) treatment. |
There were no major intrainterventional complications. In all the patients (100%) a significant improvement in the clinical status was noted. The procedure improved the quality of life in the patients. Three women (30%) had a mild recurrence of the symptoms at mid-term follow-up. Among 8 women who had complained of dyspareunia prior to embolization 6 patients reported complete pain relief, in other 2 cases the pain subsided partially. There was a significant decrease in the severity of symptoms associated with hemorrhoids. |
4 |
| 69. van der Vleuten CJ, van Kempen JA, Schultze-Kool LJ. Embolization to treat pelvic congestion syndrome and vulval varicose veins. Int J Gynaecol Obstet. 118(3):227-30, 2012 Sep. |
Observational-Tx |
21 Patients |
To evaluate the efficacy of embolization for treating the symptoms of pelvic congestion syndrome (PCS). |
All patients completed the questionnaire. Two months after the first embolization, 14 (66.7%) women had some degree of improvement of symptoms. Nine (42.9%) patients underwent a second embolization. At the time the survey was conducted, 16 (76.2%) patients had some degree of improvement of symptoms. In addition to improvements in varicose veins and pelvic pain, there was improvement of hemorrhoids. |
4 |
| 70. Siqueira FM, Monsignore LM, Rosa-E-Silva JC, et al. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome. Clinics. 71(12):703-708, 2016 Dec 01. |
Observational-Tx |
22 Patients |
To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. |
We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. |
3 |
| 71. Dos Santos SJ, Holdstock JM, Harrison CC, Whiteley MS. The effect of a subsequent pregnancy after transjugular coil embolisation for pelvic vein reflux. PHLEBOLOGY. 32(1):27-33, 2017 Feb. |
Review/Other-Dx |
8 Women |
To report the effect of subsequent pregnancy on patients that have undergone previous pelvic vein embolisation. |
Eight women, aged 32–48 years (mean 38.8), were retrospectively analysed. Parity prior to embolisation ranged from 1 to 5 (mean 2.8). Initial outcomes at 6 weeks: pelvic venous reflux was completely eliminated in five patients, two patients achieved complete elimination of truncal reflux with very minor vulval reflux and one patient had persistent, mild reflux in the right internal iliac vein. Post-pregnancy outcomes: pelvic venous reflux was completely eliminated in three patients and five patients displayed pelvic venous reflux in at least one truncal vein, with or without concurrent vulval reflux. No patient showed any coil displacement or embolisation as a result of the pregnancy. |
4 |
| 72. Gavrilov SG, Turischeva OO. Conservative treatment of pelvic congestion syndrome: indications and opportunities. Curr Med Res Opin 2017;33:1099-103. |
Review/Other-Tx |
N/A |
To describe conservative treatment methods for pelvic venous congestion. |
N/A |
4 |
| 73. Chung HH, Lee SH, Cho SB, Kim YH, Seo TS. Single-Session Endovascular Treatment of Symptomatic Lower Extremity Deep Vein Thrombosis: Is it Possible Even for Aged Thrombosis. Vascular & Endovascular Surgery. 50(5):321-7, 2016 Jul.Vasc Endovascular Surg. 50(5):321-7, 2016 Jul. |
Observational-Tx |
21 Patients |
To evaluate the feasibility and efficacy of single-session endovascular treatment of DVT of the lower extremity that is more than 10 days old. |
The technical success rate was 90.5% (19 of 21 patients). Among the 19 successful cases, aspiration thrombectomy alone was performed in 16 (84.2%) patients, additional balloon angioplasty of the femoral vein was performed in 2 (10.5%) patients, and both balloon angioplasty of the femoral vein and rotational thrombectomy were performed in 1 (5.3%) patient. Iliac vein stenting was performed due to combined iliac vein narrowing in 13 (68.4%) of the 19 successful cases. The mean procedure time was 86 minutes (26-179 minutes). All of the patients with technical success (19 of 21 patients) showed marked improvement in symptoms at the time of discharge (clinical success). Unexplained gastrointestinal hemorrhage developed in 1 patient. |
3 |
| 74. Aw-Zoretic J, Collins JD. Considerations for Imaging the Inferior Vena Cava (IVC) with/without IVC Filters. Semin Intervent Radiol 2016;33:109-21. |
Review/Other-Tx |
N/A |
To provide an overview of available techniques for imaging the vena cava with or without a filter and discuss advantages and drawbacks for each. |
No results available. |
4 |
| 75. Lin EP, Bhatt S, Rubens D, Dogra VS. The importance of monophasic Doppler waveforms in the common femoral vein: a retrospective study. J Ultrasound Med 2007;26:885-91. |
Observational-Tx |
2963 VD examinations |
To assess the importance of monophasic waveforms encountered in the common femoral vein during deep venous thrombosis evaluation by a retrospective review of lower extremity venous Doppler (VD) sonography and correlative studies, such as computed tomography (CT) and magnetic resonance imaging. |
A total of 2963 VD examinations were reviewed. One hundred twenty-four of 2963 showed monophasic waveforms. Eighty-nine of the 124 had additional CT examinations within 1 week; 19 had CT within 2 months; and 16 had no additional examinations. Forty-seven of 124 cases revealed deep venous thrombosis extending into the iliac veins, of which 23 were identified by VD sonography; 26 were due to extrinsic compression; 6 showed a hypoplastic or stenosed common iliac vein; and the remaining 45 had no apparent causes for the monophasic waveforms. |
3 |
| 76. Chen JX, Sudheendra D, Stavropoulos SW, Nadolski GJ. Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis. [Review]. Radiographics. 36(5):1565-75, 2016 Sep-Oct. |
Review/Other-Tx |
N/A |
To describe the patient- and disease-specific factors to consider before performing endovascular DVT intervention, to list the categories of currently used endovascular thrombolysis and thrombectomy modalities, and to summarize key points from the current evidence on endovascular DVT therapy. |
No results stated in abstract. |
4 |
| 77. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.[Erratum appears in Chest. 2012 Dec;142(6):1698-1704]. Chest. 141(2 Suppl):e419S-e496S, 2012 Feb. |
Review/Other-Dx |
N/A |
To review recommendations for the use of antithrombotic agents as well as the use of devices or surgical techniques in the treatment of patients with DVT and pulmonary embolism (PE). |
No results stated in abstract. |
4 |
| 78. Garcia M, Sterling K, Jaff M, et al. 3:00 PM Abstract No. 351 ¦ DISTINGUISHED ABSTRACT ACCESS PTS Study: ACCElerated thrombolySiS for post-thrombotic syndrome using the acoustic pulse thrombolysis EkoSonic ® endovascular system: midterm results of a multicenter study. Journal of Vascular and Interventional Radiology 2018;29:S151. |
Observational-Tx |
78 patients (77 limbs) |
To evaluate the efficacy and safety of endovascular recanalization of venography proven chronic venous-occlusive disease, utilizing venoplasty with ultrasound-accelerated, catheter-directed thrombolysis (USCDT). |
Of 81 patients enrolled, 78 patients (mean age 55, male 68%) received treatment and 77 limbs were evaluable for endpoint assessment. Mean USCDT duration was 22.8 ± 5.4 hours and tPA dose was 18.5 ± 7.6 mg. The Villalta score improved from 15.8 (baseline) to 9.8 and 8.2 at 30 and 180 days, respectively (p<0.0001). The actual primary endpoint was met in 67% (p = 0.003). VCSS improved from 12.3 (baseline) to 8.4 and 7.0 at 30 and 180 days, respectively (p<0.0001). VEINES-QOL improved from 60.6 (baseline) to 70.7 and 80.2 (30 and 180 days, respectively) (p<0.0001). One major bleed occurred within 72 hours post-USCDT. One PE occurred within 30 days of USCDT. |
2 |
| 79. Garcia MJ, Sterling KM, Kahn SR, et al. Ultrasound-Accelerated Thrombolysis and Venoplasty for the Treatment of the Postthrombotic Syndrome: Results of the ACCESS PTS Study. J Am Heart Assoc 2020;9:e013398. |
Observational-Tx |
82 limbs (78 patients) |
To evaluate the effectiveness of combined percutaneous transluminal venoplasty (PTV) and ultrasound-accelerated thrombolysis (USAT) to improve PTS-related symptoms and venous disease–related QOL in subjects with PTS in the presence of chronic veno-occlusive disease. |
The primary efficacy outcome was a reduction of=4 points in the Villalta score 30 days after procedure. The primary safety outcomes were major bleeding episodes within72 hours and symptomatic pulmonary embolism during the index hospitalization. A total of 82 limbs (78 patients) were treated(age, 54.612.7 years; 32.1% women; mean Villalta score, 15.55.2). The primary end point was met in 64.6% (51/79). At 1 year,77.3% (51/66) of limbs continued with a Villalta reduction =4. At 365 days, >90% of segments had patency with ultrasound flowpresent. Baseline to 1-year Physical Component Summary mean score of the Short Form-36 increased from 38.99.5 to 45.29.8(P=0.0001), and mean VEINES-QOL (Venous Insufficiency Epidemiological and Economic Study–Quality of Life) increased from61.919.7 to 82.620.8 at 1 year (P<0.0001). Iliofemoral venous stenting was performed in 42 patients, with similarimprovements seen in all outcomes, regardless of stenting status. One patient developed severe bleeding within 72 hours of theintervention and died at 32 days after procedure (1.3% mortality rate). |
2 |
| 80. Alimi YS, DiMauro P, Fabre D, Juhan C. Iliac vein reconstructions to treat acute and chronic venous occlusive disease. J Vasc Surg 1997;25:673-81. |
Review/Other-Tx |
8 patients |
To analyze different methods of reconstruction using a reinforced expanded polytetrafluoroethylene bypass graft associated with an arteriovenous fistula and their intermediate-term results. |
There was no evidence of pulmonary embolism, and no deaths were recorded in the perioperative period. Two patients had an early bypass thrombectomy, but one returned with a further graft occlusion. Seven grafts remained patent after a mean follow-up of 19.5 months (range, 10 to 45 months). One successful thrombectomy was necessary during the twenty-third postoperative month. |
4 |
| 81. Taheri SA, Williams J, Powell S, et al. Iliocaval compression syndrome. Am J Surg 1987;154:169-72. |
Review/Other-Tx |
18 patients with iliocaval compression syndrome |
To outline our experience with 18 patients with iliocaval compression syndrome and summarize the diagnostic and therapeutic approaches utilized. |
No results in abstract. |
4 |
| 82. Sista AK, Vedantham S, Kaufman JA, Madoff DC. Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art. [Review]. Radiology. 276(1):31-53, 2015 Jul. |
Review/Other-Tx |
N/A |
To provide an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article. |
No results available. |
4 |
