静脉曲张英文综述-最新Systematic Review of Treatments for Varicose Veins 01

Deanne Leopardi, BSc,1 Ben L. Hoggan, Bsc BPsych (Hons),1 Robert A. Fitridge, MS FRACS,2
Peter W.H. Woodruff, FRACS,3 and Guy J. Maddern, FRACS PhD,1,2,4
This systematic review compares the safety and efficacy of varicose vein treatments, including
conservative therapy, sclerotherapy, phlebectomy, endovenous laser therapy, radiofrequency辽宁省人民医院血管外科周玉斌
ablation, and surgery involving saphenous ligation and stripping. Systematic searches of medical
bibliographic databases were conducted in February 2008 to identify suitable studies published
from January 1988 onward. Articles were considered eligible for inclusion through the application
of a predetermined protocol. Safety and effectiveness data from the comparison of two or more
varicose vein procedures were extracted and analyzed. Seventeen studies, published between
2003 and 2007, were included in this review. Serious adverse events were rare. Minor adverse
events were more common but generally self-limiting. All treatments displayed levels of effectiveness
depending on the extent of the vein in question. Short-term advantages appeared to be associated
with sclerotherapy and endovenous treatments, and long-term effectiveness was more
apparent following surgical intervention. Evidence suggests conservative therapy is less effective
than sclerotherapy and surgery for the treatment of varicose veins. Ligation with stripping
plus phlebectomy is generally regarded as the ‘‘gold standard’’ for treating primary long saphenous
veins. Sclerotherapy and surgery both appear to have a place in the management of varicose
veins. Sclerotherapy and phlebectomy may also be more appropriate in patients with minor
superficial varicose veins not related to reflux of the saphenous system or as a post- or adjunctive
treatment to other procedures, such as surgery. Current evidence suggests endovenous laser
therapy and radiofrequency ablation are as safe and effective as surgery, particularly in the
treatment of saphenous veins. Most importantly, the type of varicose vein should govern the
intervention of choice, with no single treatment universally employed