Long-term efficacy of different procedures for treatment of varicose veins: A network meta-analysis

Abstract

Background: Various procedures for the treatment of varicose veins have been shown to have long-term effectiveness, but research has yet to identify the most effective procedure. The aim of this study was to investigate the long-term efficacy of different procedures based on Bayesian network meta-analysis and to rank therapeutic options for clinical decision-making.

Methods: Globally recognized databases, namely, MEDLINE, Embase, and Cochrane Central, were searched for randomized controlled trials (RCTs). Quantitative pooled estimation of successful treatment rate (STR) and recurrence rate (RR) was performed to assess the long-term efficacy of each procedure with more than a 1-year follow-up. The surface under the cumulative ranking (SUCRA) probabilities of the P values regarding STR and RR were calculated to rank various procedures. Grades of Recommendations Assessment, Development and Evaluation (GRADE) criteria were utilized for the recommendation of evidence from pairwise direct comparisons.

Results: A total of 39 RCTs encompassing a total of 6917 limbs were eligible and provided relative raw data. After quantitative analysis, the CHIVA procedure was determined to have the best long-term efficacy, as it had the highest STR (SUCRA, 0.37). Additionally, the results revealed that CHIVA possessed the highest probability of achieving the lowest long-term RR (SUCRA, 0.61). Moreover, the sensitivity analysis with inconsistency approach clarified the reliability of the main results, and the evidence of most direct comparisons was ranked as high or moderate.

Conclusion: CHIVA seemed to have superior clinical benefits on long-term efficacy for treating varicose veins. However, the conclusion still needs additional trials for supporting evidence.

Figure 1

Flow diagram of the process of (and the reasons for) including and excluding studies for this meta-analysis.

Figure 2

Network connections of all included trails. The numbers on the line indicate the quality of studies compared with every pair of procedures, which were also represented by the width of the lines. Additionally, the sizes of the areas of the circles stand for the respective sample sizes.

Figure 3

Scatter plot of surface under the cumulative ranking curve values of top 3 procedures regarding successful treatment rate and recurrence rate. The specific top 3 P values were also presented beneath the plot.