U.K. okays interventional procedures

October 3, 2003

An advisory body in the U.K. has given its stamp of approval to three interventional procedures, while holding back on a fourth until more evidence comes in.The National Institute for Clinical Excellence (NICE), a part of England's National Health

An advisory body in the U.K. has given its stamp of approval to three interventional procedures, while holding back on a fourth until more evidence comes in.

The National Institute for Clinical Excellence (NICE), a part of England's National Health Service, issued guidelines this week from its Interventional Procedures Program. The statements affirm the safety and efficacy of vertebroplasty, radio-frequency ablation of varicose veins, and coblation tonsillectomy. Stent-graft placement in abdominal aortic aneurysms did not receive the institute's full support.

"This work program focuses on considering new procedures and providing guidance on whether they are safe enough and work well enough for use in the National Health Service," said Andrew Dillon, NICE chief executive.

Evidence for the use of percutaneous vertebroplasty appears adequate, according to the guidelines. This procedure is performed according to the following recommendations:
? Arrangements should be made for good access to a spinal surgery service.
? Patients' pain should be refractory to more conservative treatment.
? Prior discussion should be held among a specialist multidisciplinary team that includes a radiologist and a spinal surgeon.

The opinions of specialist advisors were divided about percutaneous vertebroplasty. Some believed its efficacy was proven in the literature. Others suggested the therapy is unnecessary, the fractures will heal of their own accord, and the procedure causes further fractures at a higher level of the spine.

The institute found sufficient evidence to support RFA for treating varicose veins as an alternative to saphenofemoral ligation and stripping. In general, the evidence showed that fewer than 5% of RFA patients continued to have symptoms such as leg pain, leg fatigue, edema, and noticeable varicose veins after the procedure. The interventional advisors noted that no long-term results of this procedure are available.

The third nod was given to coblation tonsillectomy. Coblation, a term derived from the words "controlled ablation," uses low-temperature radio-frequency energy and saline conductive solution to remove tissue. At the request of NICE, the British Association of Otorhinolaryngologists, Head and Neck Surgeons is producing training standards for this procedure.

NICE found current evidence on safety and efficacy of AAA stent-graft placement lacking. It recommends using this procedure only with special arrangements for consent and for audit or research.

"Where such uncertainty exists, we advise the NHS that patients are kept fully informed and that clinicians monitor and audit the results of procedures they undertake carefully. This means that the procedures could be used in the NHS, provided that it is in a carefully controlled way," Dillon said.

For more information from the Diagnostic Imaging archives:

? Long-term data favor varicose vein therapies
http://www.dimag.com/db_area/archives/2003/0307.overread5.di.shtml

? Interventional radiology strategies treat venous insufficiency
http://www.dimag.com/cme/articles/013.shtml

? FDA warning raises interventional radiologists' ire
http://www.dimag.com/db_area/onlinenews/2003/2003041101.shtml

? Vertebroplasty relieves pain and reduces walking problems
http://www.dimag.com/db_area/onlinenews/2003/2003021301.shtml