Predictors of Recanalization of the Great Saphenous Vein in Randomized Controlled Trials 1 Year After Endovenous Thermal Ablation

S K Van der Velden; M Lawaetz; M G R De Maeseneer; L Hollestein; T Nijsten; R R van den Bos; Members of the Predictors of Endovenous Thermal Ablation Group

doi:10.1016/j.ejvs.2016.01.021

Predictors of Recanalization of the Great Saphenous Vein in Randomized Controlled Trials 1 Year After Endovenous Thermal Ablation

Eur J Vasc Endovasc Surg. 2016 Aug;52(2):234-41. doi: 10.1016/j.ejvs.2016.01.021. Epub 2016 Mar 16.

Authors

S K Van der Velden¹, M Lawaetz², M G R De Maeseneer³, L Hollestein³, T Nijsten³, R R van den Bos³; Members of the Predictors of Endovenous Thermal Ablation Group

Collaborators

Members of the Predictors of Endovenous Thermal Ablation Group:
A A Biemans, R J Darwood, B C Disselhoff, K Helmy El Kaffas, C R Lattimer, F Lurie, W S Malskat, K Atqiaee, J Perälä, P Pronk, L H Rasmussen, K Rass, R R van den Bos, M Vuylsteke

Affiliations

¹ Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands. Electronic address: s.vandervelden@erasmusmc.nl.
² Danish Vein Centers, Åreknudeklinikken, and Surgical Center Roskilde, Naestved, Denmark.
³ Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.

PMID: 26994834
DOI: 10.1016/j.ejvs.2016.01.021

Abstract

Objective/background: The objective was to identify predictors to develop and validate a prognostic model of recanalization of the great saphenous vein (GSV) in patients treated with endovenous thermal ablation (EVTA).

Methods: The search strategy of Siribumrungwong was updated between August 2011 and August 2014 using MEDLINE, Embase, and the Cochrane register to identify randomized controlled trials (RCTs), in which patients presenting with GSV reflux were treated with radiofrequency or endovenous laser ablation. Leg level data (n = 1226) of 15/23 selected RCTs were pooled. The primary outcome was recanalization of the GSV; the secondary outcome was change in health related quality of life (HRQoL) measured by the Chronic Venous Insufficiency quality of life Questionnaire or Aberdeen Varicose Vein Questionnaire 1 year post-procedure. Candidate predictors were age, sex, body mass index, clinical class, GSV diameter, saphenofemoral junction reflux, type of device, energy, and length of treated vein.

Results: At 1 year, 130 GSVs were recanalized (11%). Clinical class (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.4-3.3) and diameter (OR 1.8, 95% CI 1.2-2.7) of the GSV were the strongest predictors of recanalization. Other predictors included in the final model were sex, type of device, and length of treated vein. The performance of the recanalization model was moderate, with an area under the curve above 0.717. GSV diameter, type of device, and amount of energy delivered were the only predictors of the change of HRQoL. None of the candidate predictors were included in the final HRQoL model (R(2) = .027).

Conclusion: There are several important prognostic factors for GSV recanalization and change of HRQoL after EVTA. However, the performance of each model was unsatisfactory to allow use in clinical practice yet.

Keywords: Endovenous thermal ablation; Great saphenous vein; Health related quality of life; Recanalization; Varicose veins.

MeSH terms

Adult
Catheter Ablation*
Endovascular Procedures / methods
Female
Humans
Male
Middle Aged
Peripheral Vascular Diseases / etiology
Peripheral Vascular Diseases / surgery*
Randomized Controlled Trials as Topic
Recurrence
Risk Factors
Saphenous Vein / surgery*
Treatment Outcome