Authors' objectives:

The aims of this study are to: 1. Assess the performance of interventional treatments for leg varices. 2. Propose management strategies for leg varices before and after treatment, based on lesion classification (CEAP classification and type of reflux).

Authors' recommendations: Gold standard techniques: The 1997 ANDEM report considered resection and stripping of the great saphenous vein and its tributaries, and phlebectomy to be the two gold standard techniques for treating varices. According to more recent results, the most complete vein resection possible (resection of the great saphenous vein and its tributaries, ligation of the perforating veins, and stripping) is more effective than combining resection of the great saphenous vein and its tributaries with phlebectomy. Sclerotherapy: Obliteration techniques - conventional or transcatheter sclerotherapy and ultrasound sclerotherapy - use liquid or foam sclerosing agents. Most recent studies use foam agents. ANDEM validated conventional sclerotherapy for treatment of varices in 1997. No data published since then challenge this recommendation. At the present time it is agreed that ultrasound sclerotherapy is safer than simple sclerotherapy in treating the great saphenous veins, perforating veins, and recurrence in the groin region and popliteal fossa. Other techniques: - Endovascular techniques, radiofrequency (Closure) and laser treatment are being assessed. Short-term results for radiofrequency are similar to those for surgery; 3-year results are awaited. Studies of laser treatment are of lower quality and follow-up is shorter (18 months). - The feasibility of the V-clip (a clip inserted into the saphenous vein to flatten the venous lumen) has been studied but no study has yet provided sufficient evidence to validate the technique. - Haemodynamic correction of varicose veins in an ambulatory setting (known in France as CHIVA: Cure Hemodynamique de l'Insuffisance Veineuse en Ambulatoire) and external valvuloplasty preserve the great saphenous vein. Efficacy and safety cannot be assessed on the basis of available studies.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: L'Agence Nationale d'Accreditation d'Evaluation en Sante (ANAES)