Invasive Medical Intervention Compared with Conservative Intervention in the Treatment of Varicose Veins in Pregnant Women: Rapid Evaluation of the Evidence
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v3i2.3815
Abstract
The objective of this study was to analyze the best available scientific evidence related to conservative medical intervention compared with more invasive interventions, including surgery, for the treatment of varicose veins in the lower extremities during pregnancy and the prevention of subsequent onset. The study began with the application of the rapid evidence assessment methodology. A literature search was conducted in databases with no date limits. Inclusion criteria: Pregnant women with varicose veins in the lower extremities of any age. The types of studies analyzed were Systematic Reviews, RCTs, Meta-analyses, or Clinical Practice Guidelines in English, Portuguese, or Spanish. The FLC 2.0 and Agree II platforms were used for analysis, and the Sackett template was used for the interpretation of levels of evidence and grades of recommendation. Three articles were retrieved, and three were selected. It was determined that the recommended intervention is conservative therapy; only in exceptional cases will another intervention be determined. Invasive treatment, including surgery, is reserved for delicate cases, since the risks outweigh the benefits. It is concluded that the first-line treatment for varicose veins in pregnant women is compression stockings. Rutosides and oral anticoagulants appear to be helpful, but they are not safe to use during pregnancy.
Keywords
pregnancy; varicose-veins; conservative-treatment; pharmacological-treatment
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[20] Flórez I, Montoya D. Las guías de práctica clínica y el instrumento Agree II. Rev Colomb Psiquiatr. 2011 Jul-Sep; 40(3): 563-576. https://www.elsevier.es/es-revista-revista-colombiana-psiquiatria-379-avance-resumen-las-guias-practica-clinica-el-S0034745014601475.DOI:10.1016/S0034-7450(14)60147-5
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[22] Alcolea M, Oter C, García A. Fases de la Práctica Basada en la Evidencia. Nure Investigación. 2011 Jul-Ago; (53): 1-5. http://www.nureinvestigacion.es/OJS/index.php/nure/article/view/545/534
[23] Laguna S, Caballero C, Lewis V, Mazuera1 S, Salamanca J, Daza1 W, Fourzali A. Consideraciones éticas en la publicación de investigaciones científicas. Sal Uninor [Internet]. 2007; 23(1): 64-78. http://www.scielo.org.co/pdf/sun/v23n1/v23n1a08
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[25] Campbell B. Varicose veins and their management.BMJ. [Internet]. 2006; 333(7562): 287-92. DOI: www.10.1136/bmj.333.7562.287
[26] Bartholomew J, King T, Sahgal A, Vidimos AT. Varicose veins: newer, better treatments available. Cleveland Clinic Journal of Medicine. 2005; 72(4): 312-4, 319-21, 325-8. DOI: www.10.3949/ccjm.72.4.312
[27] Bergstein N. Clinical study on the efficacy of O-(BetaHydroxyethyl) Rutoside (HR) in varicosis of pregnancy. Journal of International Medical Research [internet]. 1975; 3: 189-93. DOI: https://doi.org/10.1177/030006057500300308
[28] Rodríguez N, Álvarez E. Actualización del tratamiento de la insuficiencia venosa en la gestación. Semergen. 2017. https://doi.org/10.1016/j.semergen.2017.11.003
[29] Greenstone M, Craig E, Massell T. Management of varicose veins during pregnancy. Calif Med. 1957 Dec; 87(6): 365-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1512200/
[30] Cleave T. Varicose Veins and Pregnancy. Br Med J. 1965; (2): 1183. https://doi.org/10.1136/bmj.2.5471.1183-C
[31] Solanki J, Fenu E, Flynn N, Ritchie G. Varicose veins in the legs. The diagnosis and management of varicose veins. National Clinical Guideline Centre. 2013 Jul. https://www.ncbi.nlm.nih.gov/pubmed/25535637
[32] Nesbitt, C; Bedenis, R; Bhattacharya, V, Satansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database of Systematic Reviews. 2014; (7). http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005624.pub3/pdf
[33] Jamieson R, Calderwood C, Greer I. The effect of graduated compression stockings on blood velocity in the deep venous system of the lower limb in the postnatal period. BJOG. 2007; 114: 1292-4. DOI: www.10.1111/j.1471-0528.2007.01421.x
[34] Carrasco E, Díaz S. Recomendaciones para el manejo de la enfermedad Venosa crónica en atención primaria. ID Médica. 2015: 12-6. https://www.semergen.es/resources/files/noticias/venosaCrocina_1.pdf
[2] Thaler E, Huch R, Huch A, Zimmermann R. Compression stockings prophylaxis of emergent varicose veins in pregnancy: a prospective randomised controlled study. Swiss Med Wkly. 2001 Dec 1; 131(45-46). DOI: www.2001/45/smw-09805
[3] Bamigboye A, Hofmeyr G. Interventions for leg edema and varicosities in pregnancy. What evidence?. Eur J Gynecol Reprod Biol. 2006 Nov; 129(1): 3-8. DOI: www.10.1016/j.ejogrb.2006.03.008
[4] Lenković M, Cabrijan L, Gruber F, Batinac T, Manestar-Blazić T, Stanić Zgombić Z, Stasić A. Effect of Progesterone and Pregnancy on the Development of Varicose Veins. Acta Dermatovenerol Croat. 2009; 17(4): 263-7. https://www.ncbi.nlm.nih.gov/pubmed/20021978
[5] Sell H, Vikatmaa P, Albäck A, Lepäntalo M, Malmivaara A.; Mahmoud O, Venermo M. Compression therapy versus surgery in the treatment of patient with varicose veins: a rct. Eur J Vasc Endovasc Surg. 2014 Jun; 47(6): 670-7. DOI: www.10.1016/j.ejvs.2014.02.015
[6] Lohr JM, Bush R. Venous disease in women: epidemiology, manifestations, and treatment. J Vasc Surg. 2013 Apr; 57(4): 37S-45S. DOI: https://doi.org/10.1016/j.jvs.2012.10.121
[7] Vandy F, Wakefield TW. Varicose veins: evaluating modern treatments, with emphasis on powered phlebectomy for branch varicosities. Interventional Cardiology. 2012 Oct; 4(5): 527-536. DOI: www.10.2217/ica.12.48
[8] Zhang S, Melander S. Varicose Veins: Diagnosis, Management and Treatment. J Nurse Pract. 2014 Jun; 10(6): 417-424. DOI: https://doi.org/10.1016/j.nurpra.2014.03.004
[9] Jundt J, Liem T, Moneta G. Venous and Lymphatic Disease [Internet]. En: Brunicardi F, Andersen D, Billiar T, et al, editores. Schwartz's Principles of Surgery. 10ma ed. USA: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com
[10] Winterborn R, Smith F. Varicose veins. Surg J. 2010 Jun; 28(6): 259-262. DOI: https://doi.org/10.1016/j.mpsur.2010.01.011
[11] Smyth R, Aflaifel N, Bamigboye AA. Interventions for varicose veins and leg oedema in pregnancy (review). Cochrane Database of Systematic Reviews. 2015; 10. DOI: www.10.1002/14651858.CD001066.pub3
[12] De Barros N, Janeiro MC, de Amorim J, Miranda F. Pregnancy and lower limb varicose veins: prevalence and risk factors. J Vasc Bras. 2010 Jun; 9(2): 29-35. DOI: http://dx.doi.org/10.1590/S1677-54492010000200004
[13] Varicose Vein Surgery. Semin intervent radiol. 2005 Sep; 22(3): 185-194. DOI: www.10.1055/s-2005-921951
[14] Kawata E, Kondoh E, Kawasaki K, Baba T, Ueda A, Kido A, Konishi, I. Utero-ovarian varices and absent inferior vena cava in pregnancy. J Obstet Gynaecol Res. 2015 Apr; 41(4): 631-4. DOI: www.10.1111/jog.12599
[15] Vargas, Z. La investigación aplicada: una forma de conocer las realidades con evidencia científica. Revista Educación. 2009; 33(1): 155-165. https://revistas.ucr.ac.cr/index.php/educacion/article/viewFile/538/589
[16] Murillo, W. La investigación científica. Monografías.com; 2008. http//www.monografias.com/trabajos15/invest-científica/investcientífica.shtm
[17] Coello P, Ezquerro O, Fargues I, García J, Marzo M, Navarra M, Pardo J, Subirana M, Urrutia G. Enfermería Basada de la Evidencia. Hacia la excelencia de los cuidados. Madrid: Difusión Avances de Enfermería.; 2004. https://ebevidencia.com/wp-content/uploads/2013/08/EBE.-Hacia-la-excelencia-en-cuidados.pdf
[18] Soberats S, Vergara E. Acerca de la práctica clínica basada en la evidencia. Rev Cubana Med Gen Integr. 1999 Jul-Ago; 15(4): 355-356. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21251999000400001
[19] González J, Buñuel A. Búsqueda eficiente de las mejores pruebas científicas disponibles en la literatura: fuentes de información primaria y secundaria. Evid Pediatr. 2006 Feb; 2(12): 1-10. https://evidenciasenpediatria.es/articulo/5026/busqueda-eficiente-de-las-mejores-pruebas-cientificas-disponibles-en-la-literatura-fuentes-de-informacion-primarias-y-secundarias
[20] Flórez I, Montoya D. Las guías de práctica clínica y el instrumento Agree II. Rev Colomb Psiquiatr. 2011 Jul-Sep; 40(3): 563-576. https://www.elsevier.es/es-revista-revista-colombiana-psiquiatria-379-avance-resumen-las-guias-practica-clinica-el-S0034745014601475.DOI:10.1016/S0034-7450(14)60147-5
[21] Sackett Dl, Rosenberg WMC, Gary JAM, Haynes RB, Richardson WS. Evidence based medicine: what is it and what it isn't. BMJ 1996; 312:71-2. DOI: www.10.1136/bmj.312.7023.71
[22] Alcolea M, Oter C, García A. Fases de la Práctica Basada en la Evidencia. Nure Investigación. 2011 Jul-Ago; (53): 1-5. http://www.nureinvestigacion.es/OJS/index.php/nure/article/view/545/534
[23] Laguna S, Caballero C, Lewis V, Mazuera1 S, Salamanca J, Daza1 W, Fourzali A. Consideraciones éticas en la publicación de investigaciones científicas. Sal Uninor [Internet]. 2007; 23(1): 64-78. http://www.scielo.org.co/pdf/sun/v23n1/v23n1a08
[24] Taylor J, Hicks C, Heller J. The hemodynamic effects of pregnancy on the lower extremity venous system. J Vasc Surg Venous Lymphat Disrd. 2018 Mar; 6(2): 246-255. http://dx.doi.org/10.1016/j.jvsv.2017.08.001
[25] Campbell B. Varicose veins and their management.BMJ. [Internet]. 2006; 333(7562): 287-92. DOI: www.10.1136/bmj.333.7562.287
[26] Bartholomew J, King T, Sahgal A, Vidimos AT. Varicose veins: newer, better treatments available. Cleveland Clinic Journal of Medicine. 2005; 72(4): 312-4, 319-21, 325-8. DOI: www.10.3949/ccjm.72.4.312
[27] Bergstein N. Clinical study on the efficacy of O-(BetaHydroxyethyl) Rutoside (HR) in varicosis of pregnancy. Journal of International Medical Research [internet]. 1975; 3: 189-93. DOI: https://doi.org/10.1177/030006057500300308
[28] Rodríguez N, Álvarez E. Actualización del tratamiento de la insuficiencia venosa en la gestación. Semergen. 2017. https://doi.org/10.1016/j.semergen.2017.11.003
[29] Greenstone M, Craig E, Massell T. Management of varicose veins during pregnancy. Calif Med. 1957 Dec; 87(6): 365-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1512200/
[30] Cleave T. Varicose Veins and Pregnancy. Br Med J. 1965; (2): 1183. https://doi.org/10.1136/bmj.2.5471.1183-C
[31] Solanki J, Fenu E, Flynn N, Ritchie G. Varicose veins in the legs. The diagnosis and management of varicose veins. National Clinical Guideline Centre. 2013 Jul. https://www.ncbi.nlm.nih.gov/pubmed/25535637
[32] Nesbitt, C; Bedenis, R; Bhattacharya, V, Satansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database of Systematic Reviews. 2014; (7). http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005624.pub3/pdf
[33] Jamieson R, Calderwood C, Greer I. The effect of graduated compression stockings on blood velocity in the deep venous system of the lower limb in the postnatal period. BJOG. 2007; 114: 1292-4. DOI: www.10.1111/j.1471-0528.2007.01421.x
[34] Carrasco E, Díaz S. Recomendaciones para el manejo de la enfermedad Venosa crónica en atención primaria. ID Médica. 2015: 12-6. https://www.semergen.es/resources/files/noticias/venosaCrocina_1.pdf
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