PREVAIT after modern open surgery and endothermal ablation - systematic review

Abstract

Introduction: Presence of varices after operative treatment (PREVAIT) is common after varicose vein intervention, and has been shown to significantly reduce the quality of life of those it affects. As such, long-term results after varicose vein surgery have to be taken into account when choosing a technique. This study aims to systematically review current evidence on the recurrence of varicose veins after three different techniques: conventional surgery (HLS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). Evidence Acquisition: A literature search was performed on the PubMed and Web of Science databases, which returned 546 studies. Fourteen studies were included. Data were extracted using predefined forms. Evidence Synthesis: A total of 2795 patient were included, corresponding to a total of 3056 legs treated. 503 legs (16,5%) were treated by HLS, 1791 (58,6%) by EVLA and 762 (25,0%) by RFA. PREVAIT was reported in 34,4% for patients treated by HLS, for a mean follow-up comprised between 18 months and 5 years; 16,6% by EVLA, for a mean follow-up between 112 days and 5 years and 6,7% of those treated by RFA, for a mean follow-up between 106 days and 5 years. Regarding patterns of recurrence, the development of new varicose veins seems to be the most common mechanism of recurrence after HLS (range: 29,8% - 91%) and EVLA (range: 40% - 81,6%), but not RFA, where recanalization of the occluded saphenous trunk accounts for up to 67,0% of the recurrences. Only one study reported quality of life related to recurrence, and included patients treated by HLS and EVLA, but no RFA. Aberdeen Varicose Vein Questionnaire (AVVQ) score, physical functioning domains of the SF-36 score and patient satisfaction were significantly worse in patients with clinical recurrence. Re-intervention rates after recurrence were reported in 5 studies, ranging between 7,7-37,7% for HLS and 0-57% for EVLA. Only one study reported data on re-intervention for RFA patients, which was 6,67%. Conclusions: Recurrence is a reliable indicator of long-term efficacy of a varicose vein treatment and appears to be more frequent after open surgery. There are several mechanisms of recurrence, but the development of new varicose veins seems to be the most common. There is clear heterogeneity among definitions of recurrence and follow-up periods in literature.