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Randomized clinical trial of the cost consequences of preopera-tive duplex examination before varicose vein surgery in Sweden
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
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Article in journal (Refereed) Submitted
URN: urn:nbn:se:uu:diva-93234OAI: oai:DiVA.org:uu-93234DiVA: diva2:166650
Available from: 2005-05-23 Created: 2005-05-23Bibliographically 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.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 53
Surgery, Varicose veins, Venous insufficiency, Surgery, Duplex, Quality of life, Cost analysis, Kirurgi
National Category
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
Available from: 2005-05-23 Created: 2005-05-23Bibliographically approved

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