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. 2013 Jun 10;2013(6):CD001486.
doi: 10.1002/14651858.CD001486.pub2.

Surgery for varicose veins: use of tourniquet

Kathryn A Rigby  1 , Simon J Palfreyman, Catherine Beverley, Jonathan A Michaels
Affiliations

Surgery for varicose veins: use of tourniquet

Kathryn A Rigby et al. Cochrane Database Syst Rev. .

Abstract

Background: Varicose vein surgery is a common surgical procedure but there is no consensus regarding the best surgical technique. The use of tourniquets during varicose vein surgery has been advocated as a means of reducing the potential for blood loss during the operation.

Objectives: To identify whether the use of a tourniquet should be recommended when undertaking surgery for the management of primary varicose veins.

Search methods: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched April 2013) and the CENTRAL (2013, Issue 3).

Selection criteria: All studies described as randomised controlled trials that examined the use of tourniquets during surgery for patients with primary varicose veins were included.

Data collection and analysis: Data from eligible studies were extracted and summarised independently by two authors. All studies were cross-checked independently by the authors.

Main results: No additional studies were included or excluded in the updated review. Twenty papers detailing 18 trials were considered. Only three trials were randomised controlled trials and were included in the review. The remaining fifteen studies were excluded for various reasons. All three included trials had a small sample size and reported the trial design, outcome measures and analysis poorly. There were also variations in the outcome measures used between the trials. In addition, there was no consistency on the reporting of mean and medians for blood loss during the operation. It was therefore not possible to pool the data to perform meta-analysis. However, the reported blood loss when using a tourniquet was between 0 and 16 ml compared to between 107 to 133 ml when not using a tourniquet (P < 0.01).

Authors' conclusions: Although there were significant quality issues with the available evidence, the use of a tourniquet would appear to reduce blood loss during surgery. There were no reported differences between the use or non-use of a tourniquet in terms of complications and morbidity. However, the available trials were not of sufficient size to detect rarer complications such as nerve damage.

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Conflict of interest statement

KR and JM report that this review was done as part of HTA commissioned research to look at cost‐effectiveness of treatments for varicose veins. This included funds for a RCT of varicose veins treatments. JM reports having received funds for private research consultancy from various companies not relating to varicose veins, some relating to vascular disease and technology appraisal in general. JM has also been awarded an NIHR programme grant for research relating to vascular services.

Update of

References

References to studies included in this review

Corbett 1989 {published data only}
    1. Corbett R, Jayakumar KN. Clean up varicose vein surgery‐‐use a tourniquet. Annals of the Royal College of Surgeons of England 1989;71(1):57‐8. [MEDLINE: ] - PMC - PubMed
Sykes 2000 {published data only}
    1. Hickey NC. Prospective randomised trial of varicose vein surgery with or without tourniquet. National Research Register. http://www.nrr.nhs.uk/ViewDocument.asp?ID=N0282000633 (accessed 15 December 2001).
    1. Sykes TC, Brookes P, Hickey NC. A prospective randomised trial of tourniquet in varicose vein surgery. Annals of the Royal College of Surgeons of England 2000;82(4):280‐2. - PMC - PubMed
    1. Sykes TCF, Brookes P, Hickey NC. A prospective randomised trial of tourniquet in varicose vein surgery. British Journal of Surgery 1999;86(Suppl. 1):14. [MEDLINE: ] - PMC - PubMed
Thompson 1990 {published data only}
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References to studies excluded from this review

Farrands 1987 {published data only}
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Fischer 1994 {published data only}
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Klenerman 1977 {published data only}
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Lahl 2000 {published data only}
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Lofqvist 1988 {published data only}
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Meyer 1997 {published data only}
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Mildner 2000 {published data only}
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Robinson 2000 {published data only}
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Tsavellas 2000 {published data only}
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Tsavellas 2000b {published data only}
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Wigger 1998 {published data only}
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Additional references

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Hickey 1998
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Kumar 1998
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References to other published versions of this review

Rigby 2002
    1. Rigby KA, Palfreyman SSJ, Beverley C, Michaels JA. Surgery for varicose veins: use of tourniquet. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD001486] - DOI - PubMed

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