III. Major scientific findings in phlebology in the past 2 years
III. Major scientific findings in
phlebology in the past 2 years
Major scientific findings in phlebology in the past 2 years
Andrew Bradbury (UK)
• ATTRACT Trial conclusions
New Engl J Med. 2017
This presentation was a summary of the available literature. Absolute contraindications include previous anaphylaxis to sclerosants and acute deep vein thrombosis. Relative contraindications include deep venous obstruction, peripheral vascular disease, a thrombophilic disorder increasing the risk of deep vein thrombosis, immobility, acute superficial vein thrombosis, pregnancy and breastfeeding, estrogen therapy, hormone replacement therapy, asthma, migraine, systemic disease associated with skin changes, obesity, advanced age, anticoagulation, pelvic tumors causing varicose veins, foramen ovale, and proposed long-distance travel.
Among patients with acute proximal deep vein thrombosis, the addition of pharmacomechanical catheter-directed thrombolysis to anticoagulation did not result in a lower risk of the postthrombotic syndrome, but did result in a higher risk of major bleeding.
• ATTRACT femoropopliteal analysis 2019
In patients with acute femoropopliteal deep vein thrombosis, pharmacomechanical catheter-directed thrombolysis did not improve short- or long-term efficacy outcomes, but it did increase bleeding.
• ATTRACT iliofemoral analysis 2019
In patients with acute iliofemoral deep vein thrombosis, pharmacomechanical catheter directed thrombolysis did not influence the occurrence of postthrombotic syndrome or recurrent venous thromboembolism. However, pharmacomechanical catheter-directed thrombolysis significantly reduced early leg symptoms and, over 24 months, reduced postthrombotic syndrome severity scores, reduced the proportion of patients who developed moderate-to-severe postthrombotic syndrome, and resulted in a greater improvement in venous disease–specific quality of life. It was pointed out that the proportion of patients benefitting is relatively small and cannot be predicted reliably at baseline. In addition, the clinical benefit is modest for most and the risk of major bleeding has tripled with pharmacomechanical catheter-directed thrombolysis. Now, there is no health economic analysis and the number needed to treated to lead to a clinically meaningful reduction in postthrombotic syndrome severity is not yet known. The primary outcome may yet change with a longer-term analysis.
• EVRA trial conclusions
New Engl J Med. 2018
Early endovenous ablation of superficial venous reflux resulted in faster healing of venous leg ulcers and more time free from ulcers than deferred endovenous ablation. However, based on the selection criteria of ulcer duration >6 months and ankle-brachial pressure index <0.8; only 7% of screened patients were eligible. Currently, we do not know if it will be clinically effective and cost effective to refer all leg ulcer patients to secondary care.
• EVRA cost-effectiveness analysis
Br J Surg. 2019
Not only is endovenous ablation of superficial venous reflux for venous leg ulcers clinically effective but it is also highly cost-effective (ICER < 5000 Euro per QALY).
