Concomitant and staged varicose tributary interventions are both safe and effective adjuncts to endovenous truncal ablative procedures

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A recent systematic review and meta-analysis compared the outcomes of both concomitant and staged superficial varicose tributary (SVT) interventions as an adjunct to endovenous truncal ablation. While both treatments demonstrated safety and efficacy, improvements in early disease severity and quality of life (QOL) scores were better in the concomitant group.

Writing in the September issues of the European Journal of Vascular and Endovascular Surgery (EJVES), Thomas M Aherne (University Hospital Galway, Galway, Ireland) and colleagues add that their results suggests concomitant intervention offers significantly lower rates of reintervention. However, they report that this benefit was not reflected by the randomised trial subgroup analysis, which identified no difference in reintervention.

Aherne and colleagues performed a systematic search of Medline through Pubmed, Embase, and the Cochrane Central Register of Controlled Trials in November 2019, including all studies comparing the outcomes of both concomitant and staged treatments for SVT as an adjunct to endovenous truncal ablation.

They write that each study was subject to an evaluation of methodological quality using the Downs and Black assessment tool, and that outcomes assessed included rates of reintervention, complications, and thrombotic events. QOL and disease severity were also analysed, and data were pooled with a random effects model.

Aherne et al included 15 studies (6,915 limbs) for analysis. They report in EJVES that reintervention rates were significantly lower in the concomitant group (6.3% vs. 36.1%) when compared with staged intervention (relative risk [RR] 0.21 [95% CI 0.07–0.62], p=0.004, I2=90%, p≤0.001). Reported complications (RR 1.14 [95% CI 0.67–1.93], p=0.64) and rates of deep venous thrombosis (RR 1.41 [95% CI 0.72–2.77] p=0.31) were similar in each group.

They add that overall disease severity (Venous Clinical Severity Score) was lower in the concomitant group (-1.16 [95% CI -1.97–-0.35] p=0.005), while QOL, assessed using the Aberdeen Varicose Vein Questionnaire, favoured concomitant treatment when measured at less than three months (weighted mean difference [WMD] -3.6 [95% CI -7.17–-0.03] p=0.5) and between three and 12 months (WMD -1.61 [95% CI -2.99–-0.23] p=0.02).


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