| Primary saphenous vein insufficiency: prospective studies on diagnostic duplex ultrasonography and endovenous treatment with endovenous radiofrequency-resistive heating | ||
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According to our findings, endovenous obliteration resulted in less postoperative pain, shorter sick leaves and faster recovery of physical function than traditional surgery. The endovenous procedure involves higher operating costs, but has potential economical advantages for employed patients due to their ability to resume work sooner. The procedures were equally efficient in eliminating reflux in the treated LSV segments. The success rate of endovenous obliteration was noticeably better than that observed in the feasibility study (III). The postoperative changes in the CEAP classification did not differ, either. The overall complication rates were similar in the two groups. The complication rate of endovenous obliteration was higher in study IV than in study III (Table 12), although this may be explained by the more thorough follow-up in study IV.
In the present study, the minimally invasive nature of the endovenous obliteration technique resulted in reduced postoperative pain. Almost half of the patients in the stripping group complained of pain and tension in the thigh two weeks after the operation, which seemed to be the main cause of prolonged sick leaves among these patients. In addition, the pain disturbed knee motion and walking, thus delaying the recovery of normal physical function.
The patients were slightly older in the stripping group, and a positive correlation between age and sick leave emerged. According to the coefficient of determination, however, age explained only 14% of the length of the sick leave. Thus, we believe that the results were not distorted by this randomization-based difference.
Our sample included employed patients, which increased influence of the indirect costs on the cost analysis. The sensitivity analysis showed that even when 25 – 40% of the patients are retired, endovenous obliteration can be economically cost-minimizing in view of society. The possible country-specific differences in the investment costs and the cost of the catheter have relatively small effects on the average cost of endovenous obliteration. In addition, since the two alternatives required approximately the same amount of other health care resources, the differences in the values of the other cost factors do not have a significant influence on the results of the cost analysis.
The results of the previous reports on the techniques of using endovenous electrosurgical devices for venous wall collagen denaturation have been so inferior that these procedures have been used only sporadically (Politowski & Zelazny 1966; Watts 1972; O"Reilly 1977; O"Reilly 1981; Griffith et al. 1989; Gradman 1994). Resently developed endovenous techniques, such as cryostripping (Etienne et al. 1997; Garde 1994), endovenous laser obliteration (Navarro et al. 2001) or angioscopic techniques (Hoshino et al. 1997), have not gained much ground, either. Although this is still the only controlled randomized trial about endovenous obliteration, it is already used in Europe and the USA. Before endovenous treatment with RF-resitive heating can establish its place in the treatment of LSV insufficiency, technical development and more scientific proof of its possible advantages are needed. The price of the catheters should also drop to convince the hospital administration of the probable cost-effectiveness of the procedure.
In conclusion, the results of study IV indicated that endovenous obliteration may offer an advantage over conventional stripping operation in terms of reduced postoperative pain, shorter sick leaves and faster return to normal activities. Endovenous obliteration was more expensive for the hospital. The total costs, which also included the costs incurred by society due to sick leaves, were no higher than the total costs of the conventional stripping operation. More information is needed on the long-term results and recurrence rates, and larger studies are required to determine the precise role of this procedure in the treatment of primary LSV insufficiency. A thorough assessment of CVD surgery would also require a long-term cost-effectiveness or cost-benefit analysis of these alternatives.