Systematic review of the efficacy and safety of treatments for varicose veins of the lower extremity

Project leader: Marisa Warmuth 
Project team: Marisa Warmuth, Ines Schumacher, Bettina Maringer
Duration: May 2011 - August 2011
Publication: HTA-Project report No 51: https://eprints.aihta.at/930

Suggested by: KAGes
Language: German

Background:
Varicose veins of the lower extremity is a sign of varicose insufficiency and is the most common venous disease in Germany. According to the study “Bonner Venenstudie” (2000-2002, N=3.072), only about 14% of men and 6% of women aged between 18 and 79 years do not have any sign of venous insufficiency, including telangiectasias, reticular veins, varicose veins, oedema, skin changes, or ulceration. Besides hereditary risk factors, advancing age, female sex, pregnancy, obesity as well as physical inactivity promote the development of varicose veins. Treatment options encompass conservative measures, conventional surgery (ligation with or without stripping) and minimally-invasive interventions (sclerotherapy, lasertherapy, radiofrequency ablation).

Aims of project:
The project aims at assessing the current evidence regarding efficacy and safety of different treatment options for varicose veins, including conventional surgery (ligation with or without stripping, phlebectomy), minimally-invasive interventions (sclerotherapy, endovenous laser therapy and endovenous radiofrequency ablation) as well as conservative measures (compression therapy). In addition, it aims at comparing the various treatment options and at defining a boundary between indicated surgery/interventions and surgery/interventions for cosmetic reasons.

Research objectives:
What is the current evidence regarding the efficacy and safety of therapeutic options (including conventional surgery, phlebectomy, minimally-invasive treatment options and conservative measures) for varicose veins of the lower extremity? Which are the indications and contraindications for conventional surgery, minimally-invasive interventions as well as compression therapy?Is there an algorithm to treat patients according to severity of disease? Is there a definition of a boundary between indicated surgery/interventions and surgery/interventions for cosmetic reasons? If not, is it possible to define such a boundary?

Methods:

• Contacting of HTA institutions/Social insurance companies who are currently working on the same topic (identification through the EUnetHTA Planned and Ongoing Projects (POP)-database) for possible collaborations
• Developing the project protocol based on the following systematic review: Australian Safety and Efficacy Register of New Interventional Procedures – Surgical. Systematic Review: Treatments for varicose veins. ASERNIP-S Report No. 69; October 2008. [Accessed 6 May 2011]
• Systematic literature search in various databases (Pubmed, The Cochrane Library, Medline via Ovid, NHS-EED-DARE-HTA) and on Web sites
• Unsystematic hand search

Time schedule/ Milestones:
May 2011: draft of project protocol, systematic literature search
June 2011: hand search, literature acquisition, literature selection, data extraction, draft of report
July 2011: draft of report
August 2011: draft of report, internal/ external review