Karen F Mauck1, Noor Asi2, Chaitanya Undavalli3, Tarig A Elraiyah2, Mohammed Nabhan2, Osama Altayar2, Mohamad Bassam Sonbol3, Larry J Prokop4, Mohammad Hassan Murad5. 1. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Mayo Clinic, Rochester, Minn. 2. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn. 3. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn. 4. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn. 5. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
Abstract
OBJECTIVE: This goal of this study was to systematically review the literature to determine if surgical intervention (open or endovascular) is superior to compression alone with respect to ulcer healing, ulcer recurrence, and time to ulcer healing in patients with lower extremity venous ulcer disease. METHODS: We conducted a comprehensive search of multiple databases for randomized controlled trials (RCTs) and comparative observational studies from 1990 to December 2013. The interventions of interest were any open or endovascular surgical interventions on the venous system in the lower extremity compared with compression alone. RESULTS: We included 11 studies (seven RCTs and four observational studies) with moderate to increased risk of bias. The meta-analysis of all studies demonstrated increased healing rate (pooled risk ratio [RR], 1.06; 95% confidence interval [CI], 1.00-1.13; I(2) = 10%) and lower risk of recurrence (RR, 0.54; 95% CI, 0.34-0.85; I(2) = 27%) with open surgical procedures compared with compression. However, the meta-analysis of only RCTs showed no difference, possibly due to imprecision. The meta-analysis of three RCTs showed no difference in time to ulcer healing, -0.41 (95% CI, -0.89 to 0.07). Two studies of endovascular surgical procedures compared with compression showed no significant difference in ulcer healing (RR, 1.65; 95% CI, 0.43-6.32). One study of open surgical venous ligation and stripping compared with endovenous laser also showed no significant difference in ulcer recurrence (RR, 0.83; 95% CI, 0.21-3.27). CONCLUSIONS: Open surgical interventions may improve lower extremity venous ulcer healing. The quality of this evidence is low because the analysis was dominated by the results of observational studies. The current evidence does not definitively support the superiority of endovascular surgical interventions compared with compression alone.
OBJECTIVE: This goal of this study was to systematically review the literature to determine if surgical intervention (open or endovascular) is superior to compression alone with respect to ulcer healing, ulcer recurrence, and time to ulcer healing in patients with lower extremity venous ulcer disease. METHODS: We conducted a comprehensive search of multiple databases for randomized controlled trials (RCTs) and comparative observational studies from 1990 to December 2013. The interventions of interest were any open or endovascular surgical interventions on the venous system in the lower extremity compared with compression alone. RESULTS: We included 11 studies (seven RCTs and four observational studies) with moderate to increased risk of bias. The meta-analysis of all studies demonstrated increased healing rate (pooled risk ratio [RR], 1.06; 95% confidence interval [CI], 1.00-1.13; I(2) = 10%) and lower risk of recurrence (RR, 0.54; 95% CI, 0.34-0.85; I(2) = 27%) with open surgical procedures compared with compression. However, the meta-analysis of only RCTs showed no difference, possibly due to imprecision. The meta-analysis of three RCTs showed no difference in time to ulcer healing, -0.41 (95% CI, -0.89 to 0.07). Two studies of endovascular surgical procedures compared with compression showed no significant difference in ulcer healing (RR, 1.65; 95% CI, 0.43-6.32). One study of open surgical venous ligation and stripping compared with endovenous laser also showed no significant difference in ulcer recurrence (RR, 0.83; 95% CI, 0.21-3.27). CONCLUSIONS: Open surgical interventions may improve lower extremity venous ulcer healing. The quality of this evidence is low because the analysis was dominated by the results of observational studies. The current evidence does not definitively support the superiority of endovascular surgical interventions compared with compression alone.
Authors: Guilherme Camargo Gonçalves de Abreu; Otacílio de Camargo; Márcia Fayad Marcondes de Abreu; José Luis Braga de Aquino Journal: J Vasc Bras Date: 2020-03-10
Authors: Juan Francisco Jiménez-García; Gabriel Aguilera-Manrique; Josefina Arboledas-Bellón; María Gutiérrez-García; Francisco González-Jiménez; Nieves Lafuente-Robles; Laura Parra-Anguita; Francisco Pedro García-Fernández Journal: Int J Environ Res Public Health Date: 2019-12-11 Impact factor: 3.390