Compression after sclerotherapy and endovenous ablations, the Italian point of view

Transcription

1 Compression after sclerotherapy and endovenous ablations, the Italian point of view Fabrizio Mariani Siena (Italy) General Secretary "Multidisciplinary Joint Committee in Phlebology" - UEMS (EU) General Secretary "European Board of Phlebology" - UEMS (EU) Member "Thematic Federation on Wound Healing" - UEMS (EU) Past President Italian College of Phlebology

2 Faculty disclosure I disclose the following financial relationships: Receive grant/research support from Ganzoni Sigvaris Fabrizio Mariani

3 The use of post-treatment compression to reduce side effects such as pain, oedema, bruising, the rate of clot formation and thromboembolic events is suggested in most guidelines, in regard to venous interventions for varicose veins including endovenous thermal ablation or sclerotherapy.

4 Effective reduction of pain and hematoma was obtained with a high local pressure by eccentric compression pads taped to the skin along the stripping channel and a compression stocking on top.

5 Lugli et al. compared postoperative pain for one week after EVLA of the GSV in patients using a special crossedtape technique that produces higher eccentric compression, compared with those not using pads. In the group using the tape technique, postoperative pain was significantly reduced (p<0.001).

6 Bakker et al. reported that MCS (35 mmhg) for periods longer than two days after GSV EVLA without simultaneous phlebectomies reduce pain and improve physical function during the first week after treatment.

7 Hamel-Desnos et al. found no significant difference, regarding pain or complications after foam sclerotherapy of the GSV, between patients with thigh-high MCS (15-20 mmhg) and those without compression.

8 Kern et al. reported that wearing MCS (23 32mmHg) for three weeks can enhance the efficacy of sclerotherapy of C1 varicose veins by improving clinical vessel disappearance. Journal of Vascular Surgery , DOI: ( /j.jvs )

9 Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement E.Rabe, H.Partsch, J.Hafner, C.Lattimer, G.Mosti, M.Neumann, T.Urbanek, M.Huebner, S.Gaillard and P.Carpentier. Phlebology, February 2017 Recommendations the use of MCS in the initial phase after GSV treatment to reduce postoperative side effects (Grade 1B) additional eccentric compression to enhance the effectiveness of MCS in the reduction of postoperative side effects (Grade 1B) not recommended routine, prolonged use of MCS for improving clinical success after GSV interventions, except for those patients with ongoing symptomatic CVD that benefit from a continued MCS treatment (Grade 1B) suggested the use of MCS after liquid sclerotherapy of C1 veins to achieve better outcomes (Grade 2B)

10 Most of the available studies have limitations. In many cases, the interface pressure is not reported or very low. The data, however, show no benefit of MCS for time periods of longer than a week. Pressure enhancement along the treated vein with additional eccentric padding may be helpful.

11 Venous narrowing of the GSV and/or collateral veins on the thigh can not be obtained only by stockings This can be reached with sustained compression of mmhg in the upright position Eccentric compression with bandage or stockings can increase local pressure to mmhg on the thigh

12 Multicenter randomized trial comparing compression with elastic stocking versus bandage after surgery for varicose veins. Mariani F. et al. J Vasc Surg 2011;53: Journal of Vascular Surgery , DOI: ( /j.jvs )

13 Our clinical experience MCS, except for large complicated varicose veins/c4-6, is better than bandage prolonged use of MCS (> 7 days) for improving clinical success after GSV procedures is not recommended, except for patients with ongoing symptomatic CVD that benefit from a continued MCS treatment or for patients at VTE risk

14 Our clinical experience MCS (23-32 mmhg) reduce side effects after EVLA and foam sclerotherapy additional eccentric compression enhances the effectiveness in the reduction of side effects

15 Varicose veins in the legs The diagnosis and management of varicose veins NICE clinical guideline July 2013 Compression after interventional treatment What is the clinical and cost effectiveness of compression bandaging or hosiery after interventional treatment for varicose veins compared with no compression? If there is benefit, how long should compression bandaging or hosiery be worn for? The benefit of compression after interventional treatment for varicose veins is still unclear

16 A multicenter RCT of compression would help determine whether compression is beneficial, and if so, what type is best and how long it should be worn for. The trial should include patients into 2 groups: endothermal ablation, ultrasound-guided foam sclerotherapy. There should be 4 RCT arms, 1 arm with compression and 1 arm without, in each of the 2 groups, it should have subgroups for compression type and duration. Adherence to compression treatment and the impact of adherence on effectiveness should also be evaluated. A cost-effectiveness analysis should be performed.