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A comparison of the effectiveness of treating those with and without the complications of superficial venous insufficiency

Carradice, Daniel; Wallace, Tom; Gohil, Risha; Chetter, Ian

Authors

Daniel Carradice

Tom Wallace

Risha Gohil

Ian Chetter



Abstract

Objective: To test the hypothesis that patients with soft tissue changes related to superficial venous insufficiency (SVI) have greater benefits from treatment than those with only symptomatic varicose veins.
Background: A commonly held view is that SVI is only a minor ailment, yet randomized clinical trials (RCTs) show that treatment improves quality of life (QoL) and is cost-effective. In an effort to curb the treatment costs of this common disorder, rationing is applied in many health care systems, often limiting the reimbursement of treatment to those with soft tissue changes.
Methods: This cohort study draws its data from an interventional RCT. After informed consent, consecutive patients with symptomatic unilateral SVI were randomized to receive surgical ligation and stripping or endovenous laser ablation. This analysis differentially studies the outcomes of patients with simple varicose veins (C2: n = 191) and soft tissue complications (C3-4: n = 76). Effectiveness outcomes measured up to 1 year included the following: Qol [short form 36 (SF36), EuroQol, and the Aberdeen Varicose Veins Questionnaire], clinical recurrence, and the need for secondary procedures. Multivariable regression analysis was used to control for potential confounding factors.
Results: Both groups saw significant improvements in QoL. All improvements were equal between groups apart from the SF36 domain of Bodily Pain, where C2 saw an improvement of 12.8 [95% confidence interval (CI): 4.8-20.8] points over C3-4 participants (P = 0.002), who also suffered more recurrence [odds ratio (OR) = 2.7, 95% CI: 1.2-6.1, P = 0.022] and required more secondary procedures (OR = 4.4, 95% CI: 1.2-16.3, P = 0.028).
Conclusions: This study suggests that rationing by clinical severity contradicts the evidence. Delaying treatment until the development of skin damage leads to a degree of irreversible morbidity and greater recurrence.

Citation

Carradice, D., Wallace, T., Gohil, R., & Chetter, I. (2014). A comparison of the effectiveness of treating those with and without the complications of superficial venous insufficiency. Annals of Surgery, 260(2), 396-401. https://doi.org/10.1097/sla.0000000000000541

Journal Article Type Article
Acceptance Date Aug 1, 2014
Publication Date 2014-08
Print ISSN 0003-4932
Electronic ISSN 1528-1140
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 260
Issue 2
Pages 396-401
DOI https://doi.org/10.1097/sla.0000000000000541
Keywords Surgery
Public URL https://hull-repository.worktribe.com/output/432639
Publisher URL https://journals.lww.com/annalsofsurgery/pages/articleviewer.aspx?year=2014&issue=08000&article=00031&type=abstract