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Randomized clinical trial of routine preoperative duplex imaging before varicose vein surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
2005 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 92, no 6, 688-694 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Duplex imaging is used increasingly for preoperative evaluation of varicose veins, but its value in terms of the long-term results of surgery is not clear.

METHODS:

Patients with primary varicose veins were randomized to operation with or without preoperative duplex imaging. Reoperation rates, clinical and duplex findings were compared at 2 months and 2 years after surgery.

RESULTS:

Two hundred and ninety-three patients (343 legs) had varicose vein surgery after duplex imaging (group 1; 166 legs) or no imaging (group 2; 177 legs). In 44 legs (26.5 per cent), duplex examination suggested a different surgical procedure than had been considered on clinical grounds; the procedure was changed accordingly for 29 legs. At 2 months, incompetence was detected at the saphenofemoral or saphenopopliteal junction (or both) in 14 legs (8.8 per cent) in group 1 and in 44 legs (26.5 per cent) in group 2 (P < 0.001). At 2 years, two legs (1.4 per cent) had undergone or were awaiting reoperation in group 1, and 14 legs (9.5 per cent) in group 2 (P = 0.002). In the remainder, major incompetence was found in 19 legs (15.0 per cent) in group 1 and in 53 (41.1 per cent) in group 2 (P < 0.001).

CONCLUSION:

Routine preoperative duplex examination led to an improvement in results 2 years after surgery for patients with primary varicose veins.

Place, publisher, year, edition, pages
2005. Vol. 92, no 6, 688-694 p.
Keyword [en]
Adult, Aged, Comparative Study, Female, Humans, Male, Middle Aged, Preoperative Care/methods, Prospective Studies, Reoperation, Research Support; Non-U.S. Gov't, Ultrasonography; Doppler; Duplex/methods, Varicose Veins/physiopathology/*surgery/*ultrasonography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93232DOI: 10.1002/bjs.4983PubMedID: 15810046OAI: oai:DiVA.org:uu-93232DiVA: diva2:166648
Available from: 2005-05-23 Created: 2005-05-23 Last updated: 2013-03-21Bibliographically approved
In thesis
1. Varicose Veins: Aspects on Diagnosis and Surgical Treatment
Open this publication in new window or tab >>Varicose Veins: Aspects on Diagnosis and Surgical Treatment
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs.

In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery.

In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex. Duplex was done postoperatively, at 2 months and 2 years. QoL was measured with SF-36 preoperatively, at 1 month, 1 year and 2 years.

After 2 years the number of reoperations were 2 in the group with preoperative duplex and 14 in the group without (p=0.002). Incompetent veins were seen in the saphenofemoral or saphenopopliteal junction in 19 and 53 legs respectively (p<0.001).

Preoperative QoL was worse in the VV patients compared to a reference population, and was normalised 2 years postoperatively. The improved surgical result in the duplex group was not reflected in a significantly higher QoL.

The lower costs for redo surgery in the duplex group did not offset the costs for duplex, partly due to more extensive primary surgery.

A significant proportion of recurrences after 2 years was new vessel formation and progression of disease. Preoperative perforating vein incompetence did not influence recurrence rate, and was abolished without specific interruption in 60% at 2 years postoperatively.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 71 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 53
Keyword
Surgery, Varicose veins, Venous insufficiency, Surgery, Duplex, Quality of life, Cost analysis, Kirurgi
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-5855 (URN)91-554-6290-1 (ISBN)
Public defence
2005-09-07, Hörsalen, St Görans Sjukhus, St Görans plan 1, Stockholm, 09:00
Opponent
Supervisors
Available from: 2005-05-23 Created: 2005-05-23Bibliographically approved

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