Factors influencing the choice of treatment modality for individual patients with varicose veins.

2.50
Hdl Handle:
http://hdl.handle.net/11287/620406
Title:
Factors influencing the choice of treatment modality for individual patients with varicose veins.
Authors:
Campbell, Bruce; Chinai, Natasha; Hollering, P; Wright, H; McCarthy, R
Abstract:
INTRODUCTION There is evidence of effectiveness for a range of different treatment modalities for varicose veins but limited information about factors that influence treatment choice for individual patients. METHODS A postal survey was sent to 438 UK members of the Vascular Society of Great Britain and Ireland. RESULTS Overall, 251 responses were received (response rate 57%). A total of 222 respondents treated varicose veins using conventional surgery (84%), endothermal ablation (82%) and foam sclerotherapy (68%). The clinical pattern of veins appeared to have the greatest influence on treatment choice. This was followed by guidance from the National Institute for Health and Care Excellence, patient expectations, facilities, cost and whether treatment was carried out in the public or private sector. Respondents were asked to indicate whether each of 13 clinical 'scenarios' (eg very extensive varicose veins in both legs) would influence them towards or against using specified treatment modalities. 'Consensus' was defined as ≥80% of responses either towards or against any treatment modality; and disagreement as 41-59% both towards and against any modality (i.e. ∼50:50 split). There was consensus towards using endothermal ablation for truncal reflux, towards UGFS for localised varicose veins and towards conventional surgery for large, extensive, bilateral veins. There was consensus against UGFS for large truncal veins, and against surgery for obese patients and those with a history of venous thromboembolism. There were important disagreements about the influence of large or extensive veins, about whether patients were obese or slim and about a prior history of venous thromboembolism. CONCLUSIONS Conventional surgery is still widely available in the UK. Disagreements about treatment choice in different clinical scenarios suggest substantial variation in the treatments patients are offered. Attention to identifying subgroups in trials would help to guide treatment choice for individual patients.
Citation:
Factors influencing the choice of treatment modality for individual patients with varicose veins. 2017:1-7 Ann R Coll Surg Engl
Publisher:
Royal College of Surgeons
Journal:
Annals of the Royal College of Surgeons of England
Issue Date:
6-Jul-2017
URI:
http://hdl.handle.net/11287/620406
DOI:
10.1308/rcsann.2017.0122
PubMed ID:
28682127
Additional Links:
http://publishing.rcseng.ac.uk/doi/abs/10.1308/rcsann.2017.0122?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
Type:
Journal Article
Language:
en
ISSN:
1478-7083
Appears in Collections:
Vascular Surgery; 2017 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorCampbell, Bruceen
dc.contributor.authorChinai, Natashaen
dc.contributor.authorHollering, Pen
dc.contributor.authorWright, Hen
dc.contributor.authorMcCarthy, Ren
dc.date.accessioned2017-09-19T10:02:55Z-
dc.date.available2017-09-19T10:02:55Z-
dc.date.issued2017-07-06-
dc.identifier.citationFactors influencing the choice of treatment modality for individual patients with varicose veins. 2017:1-7 Ann R Coll Surg Englen
dc.identifier.issn1478-7083-
dc.identifier.pmid28682127-
dc.identifier.doi10.1308/rcsann.2017.0122-
dc.identifier.urihttp://hdl.handle.net/11287/620406-
dc.description.abstractINTRODUCTION There is evidence of effectiveness for a range of different treatment modalities for varicose veins but limited information about factors that influence treatment choice for individual patients. METHODS A postal survey was sent to 438 UK members of the Vascular Society of Great Britain and Ireland. RESULTS Overall, 251 responses were received (response rate 57%). A total of 222 respondents treated varicose veins using conventional surgery (84%), endothermal ablation (82%) and foam sclerotherapy (68%). The clinical pattern of veins appeared to have the greatest influence on treatment choice. This was followed by guidance from the National Institute for Health and Care Excellence, patient expectations, facilities, cost and whether treatment was carried out in the public or private sector. Respondents were asked to indicate whether each of 13 clinical 'scenarios' (eg very extensive varicose veins in both legs) would influence them towards or against using specified treatment modalities. 'Consensus' was defined as ≥80% of responses either towards or against any treatment modality; and disagreement as 41-59% both towards and against any modality (i.e. ∼50:50 split). There was consensus towards using endothermal ablation for truncal reflux, towards UGFS for localised varicose veins and towards conventional surgery for large, extensive, bilateral veins. There was consensus against UGFS for large truncal veins, and against surgery for obese patients and those with a history of venous thromboembolism. There were important disagreements about the influence of large or extensive veins, about whether patients were obese or slim and about a prior history of venous thromboembolism. CONCLUSIONS Conventional surgery is still widely available in the UK. Disagreements about treatment choice in different clinical scenarios suggest substantial variation in the treatments patients are offered. Attention to identifying subgroups in trials would help to guide treatment choice for individual patients.en
dc.language.isoenen
dc.publisherRoyal College of Surgeonsen
dc.relation.urlhttp://publishing.rcseng.ac.uk/doi/abs/10.1308/rcsann.2017.0122?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmeden
dc.rightsArchived with thanks to Annals of the Royal College of Surgeons of Englanden
dc.subjectWessex Classification Subject Headings::Cardiology::Vascular diseasesen
dc.titleFactors influencing the choice of treatment modality for individual patients with varicose veins.en
dc.typeJournal Articleen
dc.identifier.journalAnnals of the Royal College of Surgeons of Englanden
dc.type.versionIn press (epub ahead of print)en

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