Background: In recent years endovenous intervention (EI) has emerged as a minimally invasive alternative to the open venous surgery. However, EI does not formally disconnect the deep and superficial venous systems and thus it has been hypothesized that recurrence may be greater in the absence of high venous ligation. This study aims to compare the efficacy of a hybrid endovenous approach with adjuvant high venous ligation and standard operative intervention in the management of Great Saphenous incompetence (GSI). Methods: In March 2018 Medline was systematically searched for relevant randomized controlled trials (RCT). All RCT’s comparing a hybrid approach with standard operative intervention (SI) were included. Studies were required to include at least one pre-defined outcome. Data were extracted and assessed by two reviewers. Pooled odds ratios were calculated using a random effects model. Additional subgroup analyses were performed. Results: Eight randomized controlled trials with 1,244 participants were analyzed. Pooled standardized data revealed no difference in overall recurrence (pooled OR=1.04 [95% CI, 0.49,2.23]), operative complications (pooled OR=1.14 [95% CI, 0.82,1.58]), or re-interventions (pooled OR=1.01 [95% CI, 0.46,2.21]) for the hybrid group compared with SI alone. Subgroup analysis indicated comparable recurrence outcomes for both groups in the short, medium and long term. Furthermore, no difference in recurrence was identified when the hybrid approach was compared to open surgery (pooled OR=0.59 [95% CI, 0.33,1.06]) or endovenous monotherapy (pooled OR=1.03[95% CI, 0.55,1.93]). Conclusion: The use of a hybrid approach in the management of GSI appears to offer no recurrence, re-intervention or complication benefit when compared to SI.
Read full abstract