Choosing Wisely in France, for the Treatment of Saphenous Vein Insufficiency and Recurrences

Abstract

Choosing wisely is an idea originally created in North America. It was designed to help maintaining a dialogue with patients to allow taking best decisions in the care and treatment of patients. As a consequence, despite guidelines outlining evidence of different treatments, choosing wisely takes the patient’s point of view into the focus and helps priorising therapeutic strategies in the context of specialisation, country, reimbursement and culture.

In France this dialogue was performed under the auspices of the National Professional Council of Vascular Medicine (CNPMV- Conseil National Professionnel de Médecine Vasculaire), which brings together all the societies of vascular medicine in France (representing, more than 2,000 vascular doctors).

They have elaborated 10 recommendations to choose wisely regarding the treatment of saphenous veins insufficiency and recurrences. The history, discussion and results are presented in this article.

Zusammenfassung

Die Idee des „Choosing wisely“, des klugen Entscheidens, kommt ursprünglich aus Nordamerika. Sie wurde entworfen, um mit den Patienten besser in den Dialog zu kommen. Dadurch kann bei der Pflege und Behandlung der Patienten die bestmögliche Entscheidung getroffen werden. Als Konsequenz, trotz Leitlinien in denen die Evidenz für verschiedene Behandlungen dargelegt wird, stellt „Choosing wisely“ den Blickwinkel des Patienten in den Fokus. Es hilft bei der Priorisierung therapeutischer Strategien im Zusammenhang mit Spezialisierung, Ländern, Kostenerstattung und Kultur.

In Frankreich wurde dieser Dialog unter dem National Professional Council of Vascular Medicine (CNPMV- Conseil National Professionnel de Médecine Vasculaire) durchgeführt, der alle französischen Gesellschaften für Gefäßmedizin zusammenführt (vertreten werden mehr als 2.000 Gefäßmediziner).

Sie haben 10 Empfehlungen zum “Choosing wisely” in Bezug auf Stammveneninsuffizienz und Rezidiven ausgearbeitet. Die Geschichte dazu, die Diskussion sowie die Ergebnisse werden in diesem Artikel aufgezeigt.

Schlüsselwörter

klug entscheiden - Stammvenen - endovenöse thermische Ablation - ultraschallgesteuerte Schaum-Sklerotherapie

Keywords

choosing wisely - saphenous vein - endovenous thermal ablation - ultrasound-guided foam sclerotherapy

Publikationsverlauf

Artikel online veröffentlicht:
02. August 2022

• References

• 1 Occlusion de veine saphène par laser par voie veineuse transcutanée. Actualisation de l’évaluation conduite en 2008. Service évaluation des actes professionnels. Rapport de la Haute Autorité de Santé (HAS), décembre 2016. https://www.has-sante.fr/upload/docs/application/pdf/2016-12/rapport_laser_endoveineux_vd.pdf
• 2 Hamel-Desnos C, Miserey G. Varices saphènes et récidives. Traitements d’occlusion chimique ou thermique dans l’insuffisance des veines saphènes et des récidives. Phlébologie 2018; 71: 1-8
• 3 Hamel-Desnos C, De Maeseneer M, Josnin M. et al. Great Saphenous Vein Diameters in Phlebological Practice in France: A Report of the DIAGRAVES Study by the French Society of Phlebology. Eur J Vasc Endovasc Surg 2019; 58: 96103
• 4 Myers KA, Jolley D, Clough A. et al. Outcome of Ultrasound-guided Sclerotherapy for Varicose Veins: Medium-term Results Assessed by Ultrasound Surveillance. Eur Vasc Endovasc Surg 2007; 33: 116-121
• 5 Van der Velden SK, Pichot O, van den Bos RR. et al. Management strategies for patients with varicose veins (C2-C6): results of a worldwide survey. Eur J Vasc Endovasc Surg 2015; 49: 213-220
• 6 Shadid N, Neleman P, Lawson J. et al. Predictors of recurrence of great saphenous vein reflux following treatment with ultrasound-guided foam sclerotherapy. Phlebology 2015; 30: 194-199
• 7 Venermo M, Saarinen J, Eskelinen E. et al. Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins. BJS 2016; 103: 1438-1444
• 8 Hamel-Desnos C, Desnos P, Wollmann JC. et al. Evaluation of the efficacy of polidocanol in the form of foam compared with liquid form in sclerotherapy of the greater saphenous vein: initial results. Dermatol Surg 2003; 29: 1170-1175
• 9 Rabe E, Otto J, Schliephake D. et al. Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (ESAF): a randomised controlled multicentre clinical trial. Eur J Vasc Endovasc Surg 2008; 35: 238-245
• 10 Hamel-Desnos C, Allaert FA. Liquid versus foam sclerotherapy. Phlebology 2009; 24: 240-246
• 11 Rabe E, Breu FX, Cavezzi A. et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology 2014; 29: 338-354
• 12 Nyamekye IK, Campbell B. UK Royal Society of Medicine Venous Forum VTE Advice 2020. Phlebology 2021; 36: 88-90
• 13 Rabe E, Breu FX, Flessenkämper I. et al. Sclerotherapy in the treatment of varicose veins. Der Hautarzt 2021; 72: 23-36
• 14 Boersma D, Kornmann VNN, van Eekeren RRJP. et al. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther 2016; 23: 199-211
• 15 Lawaetz M, Serup J, Lawaetz B. et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. International Angiology 2017; 36: 281-288
• 16 National Institute for Health and Clinical Excellence (NICE). Varicose veins in the legs. The diagnosis and management of varicose veins. 2013. NICE clinical guideline 168. https://www.nice.org.uk/guidance/cg168/chapter/1- recommendations
• 17 De Maeseneer MG, Kakkos SK, Aherne T. et al. Editor's Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63: 184-267
• 18 Dabbs EB, Mainsiouw LE, Holdstock JM. et al. A description of the ’smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins. Phlebology 2018; 33: 534-539
• 19 Woo HY, Kim SM, Kim D. et al. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res 2019; 96: 313-318
• 20 Hamel-Desnos C, Guias BJ, Desnos PR. et al. Foam sclerotherapy of the saphenous veins: randomized controlled trial with or without compression. Eur J Vasc Endovasc Surg 2010; 39: 500-507
• 21 Hamel-Desnos C, Desnos P, Allaert F-A. et al. Thermal ablation of saphenous veins is feasible and safe in patients older than 75 years: a prospective study (EVTA study). Phlebology 2015; 30: 525-532
• 22 Gauw SA, Lawson JA, van Vlijmen-van Keulen CJ. et al. Five-year follow-up of a randomized, controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg 2016; 63: 420-428
• 23 Rasmussen LH, Lawaetz M, Bjoern L. et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 2011; 98: 1079-1087
• 24 Rass K, Frings N, Glowacki P. et al. Same site recurrence is more frequent after endovenous laser ablation compared with high ligation and stripping of the great saphenous vein: 5-year results of a randomized clinical trial (RELACS Study). Eur J Vasc Endovasc Surg 2015; 50: 648-656