Barrier Patch Implantation during Redo Surgery for Varicose Vein Recurrences in the Groin: 1-Year Results

Identification of outcomes in clinical studies for pelvic venous disorders

OBJECTIVE

There is increasing recognition that health systems need to measure and improve the value of patient care by measuring outcomes. Chronic pelvic pain secondary to pelvic venous insufficiency can have a significant impact on the quality of life (QOL) of women affected. Despite growing recognition, pelvic venous disorders (PeVDs), an important cause of chronic pelvic pain, remain underdiagnosed. Developing a core outcome set (COS) for benchmarking care delivery enhances the standardization of care. However, there is no consensus regarding a standardized minimum set of outcomes for PeVD. We aimed to generate a list of outcomes reported in previous PeVD treatment studies to lay the foundation for developing a COS for PeVD.

METHODS

This scoping review was undertaken according to the PRISMA-ScR guidelines. Initially, screening, full-text review and extraction was conducted on studies published between 2018 and 2023. Subsequently, the search was expanded using 1-year intervals, until, over a 1-year interval, no new outcomes were recorded. Closely related outcomes were classified into domains, and domains into three core areas: disease-specific, treatment-related, and QOL-related outcomes.

RESULTS

Of the 1579 records identified, 51 publications were included. From these studies, 108 different outcomes were identified. The median number of outcomes per study was 8 (interquartile range, 6-13). Closely related outcomes were organized into 42 outcome domains, which were then categorized into 3 core outcome areas; 47.6% (20/42) were disease specific, 35.7% (15/42) treatment related, and 16.7% (7/42) were QOL related. Of the 51 included studies, disease-specific outcomes were identified in 96.1% of the studies (49/51), treatment-related outcomes in 94.1% (48/51), and QOL outcomes in only 13.7% (7/51).

CONCLUSIONS

There was significant heterogeneity in outcomes reported in PeVD studies. Most PeVD treatment studies evaluated disease-specific and treatment-related outcomes of PeVD, but few reported outcomes that measured the impact on QOL. These findings will inform the next steps in developing a COS for PeVD.

Interventions for the treatment of recurrent varicose vein disease arising from the saphenofemoral junction or the great saphenous vein: a systematic review and meta-analysis

INTRODUCTION

We investigated the safety and feasibility of the available interventions in the treatment of recurrent varicose vein disease.

EVIDENCE ACQUISITION

A systematic search on Medline, Scopus, and Web of Science for articles published by August 2024 was performed. Primary endpoints included duplex ultrasonography (DUS)-identified recurrence and clinical recurrence.

EVIDENCE SYNTHESIS

Twenty-eight studies, eleven describing endovenous thermal ablation (EVTA), four ultrasound-guided foam sclerotherapy (UGFS), and thirteen surgery (high ligation with or without stripping) encompassing 2228 limbs, were included. The overall DUS-detected recurrence estimate was 11.84% (95% CI: 7.15-17.40). EVTA displayed the lowest recurrence of 4.27% (95% CI: 0.37-10.75), followed by UGFS 11.19% (95% CI: 6.80-16.42) and surgery 23.27% (95% CI: 15.35-32.19). Statistically significant differences were observed between surgery and both EVTA (P<0.01) and UGFS (P=0.01). The overall clinical recurrence estimate was 24.91% (95% CI: 10.40-42.96) with EVTA portraying the lowest clinical recurrence of 2.37% (95% CI: 0.00-16.81), followed by surgery 31.08% (95% CI: 14.43-50.63). Subgroup analysis identified statistically significant differences between EVTA and surgery (P=0.01). Whereas non-statistically significant differences were identified between the included interventions regarding paresthesia and deep vein thrombosis (DVT), surgery exhibited higher wound infection estimates compared to EVTA of 0.00% (95% CI: 0.00-0.80) versus 4.34% (95% CI: 2.21-7.02, P<0.01). The pooled hematoma and lymphatic complication estimates for surgery were 5.04% (95% CI: 0.50-12.87) and 5.71% (95% CI: 2.91-9.22) respectively.

CONCLUSIONS

This review demonstrated the superior efficacy of EVTA over surgery in treating recurrent varicose vein disease corroborating its use as the preferred treatment, when feasible. Additionally, UGFS displayed comparable outcomes to EVTA. The notable recurrence estimates associated with surgery call into question its suitability within this context.

Recrossektomie und Barrier-Implantation

Ein häufiger Ausgangspunkt für die Rezidivvarikosis ist die Crossenregion. Ziele der Recrossektomie und Barrier-Implantation sind die Ausschaltung der Refluxquelle sowie die Rezidivprophylaxe. Der Eingriff ist technisch anspruchsvoll. Der laterale Zugangsweg unter Umgehung der narbigen Mündungsregion sowie des Lymphknotenpakets und die langstreckige Präparation des Stumpfes dienen der Komplikationsvorbeugung. Das Absetzen des Stumpfes auf Niveau der tiefen Vene, die Durchstechungsligatur mit nicht resorbierbarer Naht und die Invertierungsplastik des Stumpfendothels sind die entscheidenden OP-Schritte der Recrossektomie. Die Barrier-Implantation mittels PTFE-Patch fungiert als mechanisches Hindernis zwischen tiefem und oberflächlichem Kompartiment und trägt wesentlich zur Rezidivvermeidung bei.

"Quality of Life after Varicose Vein Surgery in Patients with High-ligation and Stripping, External Valvuloplasty and Sapheno-femoral Redo Surgery"

BACKGROUND

High-ligation and stripping (HL/S) and external valvuloplasty (eVP) with the implantation of an external device to restore the valve's function, are surgical methods to eliminate reflux at the saphenofemoral junction. Furthermore, redo-surgery (RedoS) can be performed in terms of same side groin recurrences. It is unclear, if there is a difference in quality of life (QoL) between these 3 surgical treatment options. Therefore, it was the aim of our study to elucidate QoL in patients before and after surgical treatment at the saphenofemoral junction by comparing HL/S, eVP, and RedoS.

METHODS

A total of 303 participants (156 HL/S, 81eVP, 64 RedoS) were recruited during the daily clinical routine. QoL was measured at admission and 6 weeks after the surgical procedure by means of SF-12 (12 item short form health survey) and Aberdeen Varicose Vein Questionnaire.

RESULTS

The mean value of Aberdeen Varicose Vein Questionnaire was 14.5 (SD 2.1) preoperatively and 4.9 (SD 3.3) postoperatively in the HL/S group, 16.4 (SD 1.4) preoperatively and 6.8 (SD 2.5) postoperatively in the eVP group and 15.5 (2.2) preoperatively and 5.8 (SD 4.2) postoperatively in the RedoS group, which was statistically significant (P< 0.05) in all groups. Postoperatively, the mean values were statistically significant within the groups. Concerning physical aspects of the SF-12 we found a significant improvement in the RedoS group, while mental aspects were significantly better in the HL/S and eVP group postoperatively. Nevertheless, the clinical relevance of these SF-12 differences is questionable under consideration of the minimal important difference.

CONCLUSIONS

Varicose vein surgery leads to a significant improvement of QoL in all groups. The implantation of an external patch could have a negative influence in QoL.