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Arslanturk O, Gumus F. Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of small saphenous veins. Phlebology 2023; 38:668-674. [PMID: 37644641 DOI: 10.1177/02683555231198625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND The objective of this study was to compare the early and mid-term results of radiofrequency ablation and cyanoacrylate ablation used in the treatment of small saphenous insufficiency. METHODS A total of 84 patients with isolated small saphenous vein insufficiency who underwent either cyanoacrylate ablation (CA) (Group 1, n = 40) or radiofrequency ablation (RFA) (Group 2, n = 44) were analyzed retrospectively. RESULTS The occlusion rate of target vessel was 95% in Group 1 and 93.1% in Group 2 patients, respectively, at 1-year follow-up without any significant difference. Sural nerve injury was observed in 3 (6.8%) patients in Group 2 due to the thermal damage of the RFA device. CONCLUSIONS While both techniques can be used with satisfactory and safe results in 1-year follow-up period, cyanoacrylate ablation may have a better safety profile compared to radiofrequency ablation due to lower complication rates in terms of paresthesia and sural nerve damage with similar occlusion rates.
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Affiliation(s)
- Oguz Arslanturk
- Department of Cardiovascular Surgery, Faculty of Medicine, Bulent Ecevit University, Zonguldak
| | - Fatih Gumus
- Department of Cardiovascular Surgery, Memorial Hospital, Ankara, Turkey
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Tan J, Li J, Bai X, Wang C, Xu W. One Year Follow-Up of Endovascular Microwave Ablation and Concomitant Foam Sclerotherapy in the Treatment of Primary Small Saphenous Vein Insufficiency. Ann Vasc Surg 2023; 96:374-381. [PMID: 37230316 DOI: 10.1016/j.avsg.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/10/2023] [Accepted: 04/30/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the last decade, the microwave ablation catheter specifically for treating lower extremity varicose veins has become popular. However, imited data is available on the efficacy, analysis, and evaluation of endovenous microwave ablation (EMWA) in treating SSV insufficiency. Our objective is to evaluated the feasibility, safety, and 1-year outcomes of EMWA and concomitant foam sclerotherapy of primary small saphenous vein (SSV) insufficiency. METHODS Our team carried out a single-center, retrospective analysis of 24 patients treated with EMWAand concomitant foam sclerotherapy for primary SSV insufficiency. All operations were performed using a MWA catheter and polidocanol for the trunk and branches of the SSV, respectively. The SSV occlusion rate was assessed at the 6- and 12-month follow-up examinations using duplex ultrasound. Secondary outcomes included the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) clinical class; Venous Clinical Severity Score (VCSS); Aberdeen Varicose Vein Questionnaire (AVVQ); periprocedural pain; and complications. RESULTS 100% of the cases have been technically successful. At the 6-month follow-up, all treated SSVs were occluded. The 12-month assessment duplex doppler showed anatomical success in patients with 95.8% (95% confidence interval, 0.756-0.994). The CEAP clinical class, VCSS, and the AVVQ had decreased significantly at the 6- and 12-month follow-up, respectively. CONCLUSIONS EMWA and concomitant foam sclerotherapy is a feasible and effective technique for treating SSV insufficiency.
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Affiliation(s)
- Junjie Tan
- Zhuhai hospital affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, Guangdong, China
| | - Jihua Li
- Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, Guangdong, China
| | - Xiao Bai
- Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, Guangdong, China
| | - Chunyan Wang
- Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, Guangdong, China
| | - Weiguo Xu
- Zhuhai hospital affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, Guangdong, China; Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, Guangdong, China.
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Kibrik P, Chait J, Arustamyan M, Alsheekh A, Kenney K, Marks N, Hingorani A, Ascher E. Success rate and factors predictive of redo endothermal ablation of Small Saphenous veins. J Vasc Surg Venous Lymphat Disord 2021; 10:395-401. [PMID: 34715387 DOI: 10.1016/j.jvsv.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Endothermal ablation as endothermal laser ablation (EVLA) or Radiofrequency ablation (RFA) is being progressively more employed for small saphenous vein (SSV) insufficiency treatment. Prior studies have shown recurrence rates of 0% to 10% in incompetent small saphenous veins (ISSVs). The objective of this study is to determine the efficacy of redo venous ablations for symptomatic recanalized SSVs and to predict factors related with recanalization. METHODS A retrospective analysis of 2,566 procedures in 1,752 patients with CVI due to ISSVs from 2012 to 2018 was performed, using individual chart review for data extraction. All 2,566 procedures were performed using endothermal ablation in patients who failed initial conservative management. Postoperative duplex ultrasound scans were performed within 3 to 7 days. We defined a successful obliteration as a lack of color flow by postoperative duplex scan. We defined recanalization as the presence of reflux on duplex ultrasound in the target vessel at follow-up. We conducted follow-ups every 3 months in the first year, followed by every 6 months subsequently. RESULTS Among the 2,566 procedures, redo ablation was performed in 91 ISSVs (86 patients), including 58 women and 28 men. 54 procedures were performed on the left lower extremity, 37 were performed on the right lower extremity. The average Body Mass Index (BMI) was 32.2 ± 7.66. The mean age was 62.4 ± 15.10 years. Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classes of the patients were: C1, 0; C2, 0; C3, 29; C4, 43; C5, 1; and C6, 18. The mean maximum diameter of the targeted veins, for the redo procedures, was 4.51± 1.33 mm. Forty procedures were performed using EVLA, 51 were performed using RFA. Initial technical success was 98.9%. Redo procedures had an early closure of 96.7%. At follow up after a mean duration of 24.9 ± 14.9 months, closure was 96.5%. No correlation was found between successful obliteration in the redo procedure and age, gender, CEAP, laterality, EVLA vs. RFA, BMI, or vein diameter. CONCLUSIONS Rates of successful closure for ISSVs on initial and redo procedures are comparable. The data validate the potential usefulness of performing redo SSV ablations.
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Affiliation(s)
- Pavel Kibrik
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
| | - Jesse Chait
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
| | - Michael Arustamyan
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
| | - Ahmad Alsheekh
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
| | - Kevin Kenney
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
| | - Natalie Marks
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
| | - Anil Hingorani
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
| | - Enrico Ascher
- Vascular Institute of New York, Pavel Kibrik D.O, 960 50th street, Brooklyn, NY 11219
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Mura S, De Biasio F, Zingaretti N, Scalise A, Parodi PC. Common Peroneal Nerve Injury Related to Small Saphenous Vein Surgery: Report of 2 Cases and Review of the Literature. Case Rep Neurol 2021; 13:24-30. [PMID: 33613240 PMCID: PMC7879273 DOI: 10.1159/000509683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Although iatrogenic damage is less often involved, deep nerve injuries are reported especially as a result of small saphenous vein (SSV) dissection. Complete or partial division of the common peroneal nerve (CPN) during varicose vein operations causes substantial and serious disability. Most CPN injuries recover spontaneously; nonetheless, some require nerve surgery. Treatment depends on the nature of CPN injury. This report chronicles 2 instances of CPN injury after SSV surgery, addressing treatment strategies and therapeutic gains. The pertinent literature is also reviewed.
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Affiliation(s)
- Sebastiano Mura
- Plastic and Reconstructive Surgery, Department of Medical Area, Academic Hospital of Udine, Udine, Italy
| | - Fabrizio De Biasio
- Plastic and Reconstructive Surgery, Department of Medical Area, Academic Hospital of Udine, Udine, Italy
| | - Nicola Zingaretti
- Plastic and Reconstructive Surgery, Department of Medical Area, Academic Hospital of Udine, Udine, Italy
| | - Anna Scalise
- Clinical Neurology Unit, Department of Neurosciences, Academic Hospital of Udine, Udine, Italy
| | - Pier Camillo Parodi
- Plastic and Reconstructive Surgery, Department of Medical Area, Academic Hospital of Udine, Udine, Italy
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Guo L, Huang R, Zhao D, Xu G, Liu H, Yang J, Guo T. Long-term efficacy of different procedures for treatment of varicose veins: A network meta-analysis. Medicine (Baltimore) 2019; 98:e14495. [PMID: 30762775 PMCID: PMC6408126 DOI: 10.1097/md.0000000000014495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Various procedures for the treatment of varicose veins have been shown to have long-term effectiveness, but research has yet to identify the most effective procedure. The aim of this study was to investigate the long-term efficacy of different procedures based on Bayesian network meta-analysis and to rank therapeutic options for clinical decision-making. METHODS Globally recognized databases, namely, MEDLINE, Embase, and Cochrane Central, were searched for randomized controlled trials (RCTs). Quantitative pooled estimation of successful treatment rate (STR) and recurrence rate (RR) was performed to assess the long-term efficacy of each procedure with more than a 1-year follow-up. The surface under the cumulative ranking (SUCRA) probabilities of the P values regarding STR and RR were calculated to rank various procedures. Grades of Recommendations Assessment, Development and Evaluation (GRADE) criteria were utilized for the recommendation of evidence from pairwise direct comparisons. RESULTS A total of 39 RCTs encompassing a total of 6917 limbs were eligible and provided relative raw data. After quantitative analysis, the CHIVA procedure was determined to have the best long-term efficacy, as it had the highest STR (SUCRA, 0.37). Additionally, the results revealed that CHIVA possessed the highest probability of achieving the lowest long-term RR (SUCRA, 0.61). Moreover, the sensitivity analysis with inconsistency approach clarified the reliability of the main results, and the evidence of most direct comparisons was ranked as high or moderate. CONCLUSION CHIVA seemed to have superior clinical benefits on long-term efficacy for treating varicose veins. However, the conclusion still needs additional trials for supporting evidence.
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Affiliation(s)
- Liqin Guo
- School of Nursing, Huanggang Polytechnic College, Huanggang
| | - Rong Huang
- School of Nursing, Huanggang Polytechnic College, Huanggang
| | - Dunyong Zhao
- Institute of Digestive, Southwest Hospital, Third Military Medical University, Chongqing
| | - Guilian Xu
- School of Nursing, Huanggang Polytechnic College, Huanggang
| | - Hui Liu
- Department of Integrated Science, Huanggang Maternal and Child Health-Care Hospital, Huanggang
| | - Jian Yang
- School of Nursing, Huanggang Polytechnic College, Huanggang
| | - Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Abstract
Open and endovenous surgery of varicose veins provides an excellent way to treat varicose veins. However, there are great differences in the how the techniques are performed. No matter which procedure is carried out, there are standards that should be observed. The state of the art of open venous surgery with radical crossectomy is well-known, but unfortunately is still not always performed correctly nowadays. The state of the art of endovenous surgery has unfortunately not yet been sufficiently documented, but should be based on open-surgical techniques. How the standard of both methods today is (or should be) is described in detail in this work. A recurrence definition which applies to both techniques, is set up.
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Paravastu SCV, Horne M, Dodd PDF. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev 2016; 11:CD010878. [PMID: 27898181 PMCID: PMC6464398 DOI: 10.1002/14651858.cd010878.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Short (or small) saphenous vein (SSV) varices occur as a result of an incompetent sapheno-popliteal junction, where the SSV joins the popliteal vein, resulting in reflux in the SSV; they account for about 15% of varicose veins. Untreated varicose veins may sometimes lead to ulceration of the leg, which is difficult to manage. Traditionally, treatment was restricted to surgery or conservative management. Since the 1990s, however, a number of minimally invasive techniques have been developed; these do not normally require a general anaesthetic, are day-case procedures with a quicker return to normal activities and avoid the risk of wound infection which may occur following surgery. Nerve injury remains a risk with thermal ablation, but in cases where it does occur, the injury tends to be transient. OBJECTIVES To compare the effectiveness of endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS) versus conventional surgery in the treatment of SSV varices. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Specialised Register (last searched 17 March 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2). We searched clinical trials databases for details of ongoing or unpublished studies. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) comparing EVLA, endovenous RFA or UGFS with conventional surgery in the treatment of SSV varices for inclusion. DATA COLLECTION AND ANALYSIS We independently reviewed, assessed and selected trials that met the inclusion criteria; any disagreements were resolved by discussion. We extracted data and used the Cochrane's tool for assessing risk of bias. When the data permitted, we performed either fixed-effect meta-analyses with odds ratios (ORs) and 95% confidence intervals (CIs) or random-effects meta-analyses where there was moderate to significant heterogeneity. MAIN RESULTS We identified three RCTs, all of which compared EVLA with surgery; one also compared UGFS with surgery. There were no trials comparing RFA with surgery. The EVLA versus surgery comparison included 311 participants: 185 received EVLA and 126 received surgery. In the UGFS comparison, each treatment group contained 21 people. For several outcomes in the EVLA comparison, only a single study provided relevant data; as a result, the current review is limited in its ability to demonstrate meaningful results for some planned outcomes. The quality of evidence according to GRADE was moderate to low for the outcome measures in the EVLA versus surgery comparison, but low for the UGFS versus surgery comparison. Reasons for downgrading in the EVLA versus surgery comparison were risk of bias (for some outcomes, the outcome assessors were not blinded; and in one study the EVLA-surgery allocation of 2:1 did not appear to be prespecified); imprecision (data were only available from a single small study and the CIs were relatively wide); indirectness (one trial reported results at six months rather than one year and was inadequately powered for SSV varices-only analysis). Reasons for downgrading in the UGFS versus surgery comparison were imprecision (only one trial offered UGFS and several participants were missing from the analysis) and a limitation in design (the study was inadequately powered for SSV participants alone).For the EVLA versus surgery comparison, recanalisation or persistence of reflux at six weeks occurred less frequently in the EVLA group than in the surgery group (OR 0.07, 95% CI 0.02 to 0.22; I2 = 51%; 289 participants, 3 studies, moderate-quality evidence). Recurrence of reflux at one year was also less frequent in the EVLA group than in the surgery group (OR 0.24, 95% CI 0.07 to 0.77; I2 = 0%; 119 participants, 2 studies, low-quality evidence). For the outcome clinical evidence of recurrence (i.e. presence of new visible varicose veins) at one year, there was no difference between the two treatment groups (OR 0.54, 95% CI 0.17 to 1.75; 99 participants, 1 study, low-quality evidence). Four participants each in the EVLA and surgery groups required reintervention due to technical failure (99 participants, 1 study, moderate-quality evidence). There was no difference between the two treatment groups for disease-specific quality of life (QoL) (Aberdeen Varicose Veins Questionnaire) either at six weeks (mean difference (MD) 0.15, 95% CI -1.65 to 1.95; I2 = 0%; 265 participants, 2 studies, moderate-quality evidence), or at one year (MD -1.08, 95% CI -3.39 to 1.23; 99 participants, 1 study, low-quality evidence). Main complications reported at six weeks were sural nerve injury, wound infection and deep venous thrombosis (DVT) (one DVT case in each treatment group; EVLA: 1/161, 0.6%; surgery 1/104, 1%; 265 participants, 2 studies, moderate-quality evidence).For the UGFS versus surgery comparison, there were insufficient data to detect clear differences between the two treatment groups for the two outcomes recanalisation or persistence of reflux at six weeks (OR 0.34, 95% CI 0.06 to 2.10; 33 participants, 1 study, low-quality evidence), and recurrence of reflux at one year (OR 1.19, 95% CI 0.29 to 4.92; 31 participants, 1 study, low-quality evidence). No other outcomes could be reported for this comparison because the study data were not stratified according to saphenous vein. AUTHORS' CONCLUSIONS Moderate- to low-quality evidence exists to suggest that recanalisation or persistence of reflux at six weeks and recurrence of reflux at one year are less frequent when EVLA is performed, compared with conventional surgery. For the UGFS versus conventional surgery comparison, the quality of evidence is assessed to be low; consequently, the effectiveness of UGFS compared with conventional surgery in the treatment of SSV varices is uncertain. Further RCTs for all comparisons are required with longer follow-up (at least five years). In addition, measurement of outcomes such as recurrence of reflux, time taken to return to work, duration of procedure, pain, etc., and choice of time points during follow-up should be standardised such that future trials evaluating newer technologies can be compared efficiently.
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Affiliation(s)
| | - Margaret Horne
- The University of Edinburgh Medical SchoolCentre for Population Health SciencesTeviot PlaceEdinburghUK
| | - P Dominic F Dodd
- Northern General HospitalSheffield Vascular InstituteHerries RoadSheffieldUKS5 7AU
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Rikimaru H. Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery. Ann Vasc Dis 2016; 9:188-192. [PMID: 27738460 DOI: 10.3400/avd.oa.16-00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/02/2016] [Indexed: 11/13/2022] Open
Abstract
We evaluated thrombus extension in the proximal stump of the saphenous vein at 6 days, 4 weeks, and 16 weeks after saphenous vein surgery performed between July 2013 and March 2014 (18 patients, 29 limbs, and 31 stumps) using duplex ultrasonography. All thrombotic events were classified as endovenous heat-induced thrombosis (EHIT). Thrombus was observed in 27 stumps (87.1%), with only four (12.9%) stumps remaining without thrombus on postoperative day 6. Thrombus as EHIT class 2 was observed in one stump and as EHIT class 3 in another; in the remaining 25 stumps, it was observed as EHIT class 1 postoperatively. No further extension of thrombus was found at 4 and 16 weeks after surgery. The rate of thrombus formation in the proximal stump of the saphenous vein after conventional surgery is comparatively higher than that after thermoablation techniques. Further studies are required to determine adequate evaluation methods and appropriate therapies for stump thrombosis after varicose vein surgery. (This article is a translation of J Jpn Coll Angiol 2015; 55: 105-110).
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Affiliation(s)
- Hiroto Rikimaru
- Department of Vascular Surgery, Tome City Hospital, Tome, Miyagi, Japan
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9
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Naoum JJ, Hunter GC. Pathogenesis of Varicose Veins and Implications for Clinical Management. Vascular 2016; 15:242-9. [DOI: 10.2310/6670.2007.00069] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Varicose veins (VVs) classically result from venous hypertension owing to incompetence of the major communications between the superficial and deep veins of the lower extremity. In a significant number of patients, there is no demonstrable truncal saphenous reflux and varicosities are the result of isolated perforating and nonsaphenous vein incompetence. The clinical and histologic features of VVs are the result of disruption of the normal architectural structure of the venous wall as a consequence of remodeling of the extracellular matrix (ECM) in response to increased venous distention and altered hemodynamic shear stress. Although a number of genes, growth factors, proteases, and their inhibitors known to modulate the ECM have been implicated in the pathogenesis of VVs, their etiology remains unknown. The complex variations in venous anatomy in patients with VVs require detailed vein mapping to determine the source and drainage locations of reflux if the rates of residual and recurrent varicosities are to be reduced. The distinct pathogenic mechanisms involved in the development of VVs have important implications for the management of VVs that include a wide spectrum of treatment modalities ranging from reassurance, alternative medicines, conservative management or compression therapy, and surgical or endovascular therapy.
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Affiliation(s)
- Joseph J. Naoum
- *The Methodist Hospital, Methodist DeBakey Heart Center, Houston, TX; †Carl T. Hayden VA Medical Center, Phoenix, AZ
| | - Glenn C. Hunter
- *The Methodist Hospital, Methodist DeBakey Heart Center, Houston, TX; †Carl T. Hayden VA Medical Center, Phoenix, AZ
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10
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Hong KP. Midterm Clinical Outcomes after Modified High Ligation and Segmental Stripping of Incompetent Small Saphenous Veins. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:398-403. [PMID: 26665106 PMCID: PMC4672974 DOI: 10.5090/kjtcs.2015.48.6.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to evaluate the midterm clinical outcomes after modified high ligation and segmental stripping of small saphenous vein (SSV) varicosities. Methods Between January 2010 and March 2013, 62 patients (69 legs) with isolated primary small saphenous varicose veins were enrolled in this study. The outcomes measured were reflux in the remaining distal SSV, the recurrence of varicose veins, the improvement of preoperative symptoms, and the rate of postoperative complications. Results No major complications occurred. No instances of the recurrence of varicose veins at previous stripping sites were noted. Three legs (4.3%) showed reflux in the remaining distal small saphenous veins. The preoperative symptoms were found to have improved in 96.4% of the cases. Conclusion In the absence of flush ligation of the saphenopopliteal junction, modified high ligation and segmental stripping of small saphenous vein varicosities with preoperative duplex marking is an effective treatment method for reducing postoperative complications and the recurrence of SSV incompetence.
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Affiliation(s)
- Ki Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital
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11
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Boersma D, Kornmann VNN, van Eekeren RRJP, Tromp E, Ünlü Ç, Reijnen MMJP, de Vries JPPM. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther 2015; 23:199-211. [PMID: 26564912 DOI: 10.1177/1526602815616375] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. METHODS A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A random-effects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means. RESULTS The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). CONCLUSION Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance.
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Affiliation(s)
- Doeke Boersma
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Verena N N Kornmann
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and Statistics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Çagdas Ünlü
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
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Nandhra S, El-sheikha J, Carradice D, Wallace T, Souroullas P, Samuel N, Smith G, Chetter IC. A randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. J Vasc Surg 2015; 61:741-6. [PMID: 25720930 DOI: 10.1016/j.jvs.2014.09.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND This randomized clinical trial compared endovenous laser ablation (EVLA) and surgical ligation with attempted stripping in the treatment of small saphenous vein (SSV) insufficiency. The early results demonstrated that EVLA was more likely to eradicate axial reflux and was also associated with a faster recovery, lower periprocedural pain, and fewer sensory complications. The aim of this 2-year follow-up was to establish whether these benefits remained stable over time and whether these improved technical outcomes were associated with less clinical recurrence. METHODS Patients with primary saphenopopliteal junction and SSV reflux were randomized to EVLA or saphenopopliteal junction ligation and attempted stripping/excision. Outcomes assessed at 2 years included the presence of residual or recurrent reflux, clinical recurrence, sensory complications, the need for secondary intervention, and patient-reported quality of life on the Aberdeen Varicose Veins Questionnaire, SF-36, and EuroQol. RESULTS Of 106 patients who were equally randomized and successfully treated according to the protocol, 88 (83%) were successfully assessed at 2 years. The groups were comparable at baseline. At 2 years, EVLA remained superior to surgery in eradicating axial reflux in 36 patients (81.2%) compared with 29 (65.9%) in the surgery group (P = .002). There was no significant difference in clinical recurrence (EVLA: seven of 44 [16%] vs surgery: 10 of 44 [23%]; P = .736), sensory disturbance (EVLA: one [2.4%] vs surgery vs three [6.8%]; P = 1.000) or any quality of life domain. CONCLUSIONS The results of treatment of SSV insufficiency with EVLA appear durable up until 2 years. The study does not appear to suggest that the improved abolition of reflux after EVLA compared with surgery is associated with superior outcomes than those seen after surgery by this time point, because equal effect was shown in both groups. The sensory disturbance associated with surgery appears to settle over this time frame. EVLA is therefore superior in the short-term and not inferior by 2 years.
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Affiliation(s)
- Sandip Nandhra
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - Joseph El-sheikha
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Daniel Carradice
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Tom Wallace
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Panos Souroullas
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Nehemiah Samuel
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - George Smith
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Ian C Chetter
- Academic Vascular Unit, Hull York Medical School, University of Hull, Hull, United Kingdom
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Testroote MJG, Wittens CHA. Prevention of venous thromboembolism in patients undergoing surgical treatment of varicose veins. Phlebology 2013; 28 Suppl 1:86-90. [DOI: 10.1177/0268355512475121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: There is no consensus among surgeons with regard to prevention of venous thromboembolism (VTE) in patients undergoing surgical treatment of varicose veins. We performed a systematic review of the available literature. Methods: We systematically searched the online database from PubMed for studies about the incidence of VTE and thromboprophylaxis in varicose vein surgery. We included 13 papers for review. Results: The incidence of VTE after varicose vein surgery remains unclear. Most retrospective case series report an incidence of deep venous thrombosis (DVT) of approximately 1%, based on a clinical diagnosis. However, three prospective studies have systematically detected DVT by means of duplex ultrasound and showed that the true incidence might be 5–10 times higher than expected on a clinical basis. Discussion: More data on the incidence of VTE, and the need for postoperative thromboprophylaxis are necessary to formulate evidence-based clinical guidelines. Therefore, high-quality randomised clinical trials, with high numbers of included patients, and ideally comparing prophylaxis to placebo are warranted.
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Affiliation(s)
- M J G Testroote
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C H A Wittens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Universiteitssingel 50, The Netherlands
- Klinik für Gefäßchirurgie, Universitätsklinikum Aachen, Aachen, Germany
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14
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Randomized Clinical Trial of Endovenous Laser Ablation Versus Conventional Surgery for Small Saphenous Varicose Veins. Ann Surg 2013; 257:419-26. [DOI: 10.1097/sla.0b013e318275f4e4] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Fibular Nerve Injury After Small Saphenous Vein Surgery. Ann Vasc Surg 2012; 26:729.e11-5. [DOI: 10.1016/j.avsg.2011.11.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/05/2011] [Accepted: 11/15/2011] [Indexed: 11/18/2022]
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16
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Samuel N, Wallace T, Carradice D, Shahin Y, Mazari FAK, Chetter IC. Endovenous Laser Ablation in the Treatment of Small Saphenous Varicose Veins. Vasc Endovascular Surg 2012; 46:310-4. [DOI: 10.1177/1538574412443316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nehemiah Samuel
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - T. Wallace
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - D. Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - Y. Shahin
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - F. A. K. Mazari
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - I. C. Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
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17
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Samuel N, Carradice D, Wallace T, Smith GE, Mazari FAK, Chetter I. Saphenopopliteal ligation and stripping of small saphenous vein: does extended stripping provide better results? Phlebology 2012; 27:390-7. [PMID: 22267488 DOI: 10.1258/phleb.2011.011063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Saphenopopliteal ligation (SPL) for venous insufficiency is a challenging procedure, with mixed results being reported. The role of stripping of the small saphenous vein (SSV) is contentious. This prospective observational study aimed to assess the risks and benefits of this procedure. METHODS Fifty patients underwent SPL under general anaesthesia by a single surgeon in a tertiary referral vascular centre. The aim was to perform inversion stripping in each case, but in a proportion this was not possible. Patients were grouped into SPL with short segment excision ≤5 cm (n = 23) and SPL with extended stripping >5 cm (n = 27). Outcome measures included venous clinical severity scores (VCSS), quality of life (QoL), Aberdeen varicose vein questionnaire (AVVQ), patient satisfaction, recurrence and complication rates. RESULTS Intragroup analysis demonstrated statistically significant improvements in VCSS (P < 0.001), and QoL measures (generic and disease-specific AVVQ) (P < 0.050) with both treatments. Intergroup analysis demonstrated statistically significant superior VCSS scores at one year (P = 0.001), AVVQ at three months and one year (P < 0.05), and cosmetic satisfaction at one year (P = 0.011) in the SPL extended stripping group. There was no difference in clinical recurrence 1/23 (4.3%) versus 1/27 (3.7%) (P = 0.900) or complication rates (P > 0.050). CONCLUSIONS SPL with or without stripping is an effective procedure improving clinical severity and QoL in the short term. Early outcomes favour SPL with extended stripping to offer greater improvement in disease-specific QoL, venous severity and cosmesis. With this small sample, there is no evidence of increased complications following stripping, or increased short-term recurrence without it. Greater numbers and follow-up are required to make firm conclusions.
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Affiliation(s)
- N Samuel
- Academic Vascular Surgical Unit, Tower Block, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK.
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18
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Ikponmwosa A. Reply to letter regarding ‘Outcome following saphenopopliteal surgery: a prospective observational study’ by A Ikponmwosa. Phlebology 2010;25:174–8. Phlebology 2011. [DOI: 10.1258/phleb.2011.011r02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Ikponmwosa
- Vascular Surgery Registrar, York Teaching Hospital NHS Foundation Trust, Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK
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19
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Kim SY, Park EA, Shin YC, Min SI, Lee W, Ha J, Kim SJ, Min SK. Preoperative determination of anatomic variations of the small saphenous vein for varicose vein surgery by three-dimensional computed tomography venography. Phlebology 2011; 27:235-41. [DOI: 10.1258/phleb.2011.011023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To define the anatomical variations of small saphenous vein (SSV) for varicose vein (VV) surgery by three-dimensional computed tomography venography (3D-CTV) and to analyse the impact of this preoperative evaluation on surgical outcomes. Methods A total of 120 consecutive limbs with SSV insufficiency having undergone VV surgery from January 2005 until December 2007 were enrolled. The medical records and images were analysed retrospectively. Results The relationship between SSV and gastrocnemial vein (GNV) were categorized into two: (a) SSV and GNV drained to popliteal vein (PV) separately (100 limbs, 87%) and (b) SSV and GNV made common channel which drained to PV (15 limbs, 13%). Saphenopopliteal junction morphology was normal (75 limbs), severe tortuosity near PV (19 limbs), ampullary ectasia (4 limbs) and duplicated drainage to PV (2 limbs). No recurrence of VV was noted. Conclusions CTV can provide thorough preoperative anatomic information of the SSV variations and reduce the recurrence of VV.
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Affiliation(s)
| | - E-A Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - W Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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20
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Changing to endovenous treatment for varicose veins: How much more evidence is needed? Surgeon 2011; 9:150-9. [DOI: 10.1016/j.surge.2010.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/30/2010] [Accepted: 11/02/2010] [Indexed: 11/18/2022]
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21
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Tellings SS, Ceulen RPM, Sommer A. Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature. Phlebology 2011; 26:179-84. [PMID: 21357623 DOI: 10.1258/phleb.2010.009095] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In 15% of all patients, varicosis is caused by insufficiency of the small saphenous vein (SSV). In the past it was common to entirely remove the SSV by surgical procedure; however, recently minimally invasive techniques have taken over a significant number of varicose vein treatments. The aim of this paper is a review of the literature of all treatment modalities of the insufficient SSV. The search aimed to identify all papers published describing one or more treatments for SSV insufficiency. International literature databases were searched through for articles eligible for this review. Articles describing one or more treatment techniques for SSV insufficiency were eligible for this review. Also studies describing SSV as well as greater saphenous vein were included as long as they made a clear distinction in their results between the two groups. Studies were excluded if they did not use ultrasound examination to qualify outcome, as this is the golden standard to evaluate venous insufficiency. Seventeen articles were included in this review. Five articles on surgical treatment showed success rates varying from 24% to 100% (follow-up 1.5-60 months). Ten articles on endovenous laser ablation (EVLA) showed success rates varying from 91% to 100% (follow-up 1.5-36 months). Two articles on ultrasound-guided foam sclerotherapy (UGFS) showed success rates varying from 82% to 100% (follow-up 1.5-11 months). Statistical analysis showed a significant difference (P < 0.05) in success rate of 47.8% versus 94.9% for surgery and EVLA/UGFS, respectively. Most complications for all treatment techniques were mild and self-limiting. Rates of deep venous thrombosis were not described often and in the articles that mentioned it, varied from 1.8% to 3.5% (surgery) and 2.5-5.7% for EVLA. In the absence of large, comparative randomized clinical trials, minimally invasive techniques appear to have a tendency towards better results than surgery, in the treatment of the insufficient SSV.
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Affiliation(s)
- S S Tellings
- Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
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22
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Sonnenberg S, Gowland-Hopkins NF. Duplex scanning is no substitute for surgical expertise in identifying the saphenopopliteal junction: results following short saphenous vein surgery. Phlebology 2010; 25:252-6. [PMID: 20870873 DOI: 10.1258/phleb.2009.009054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Short saphenous vein (SSV) surgery carries a high risk of failure to identify the saphenopopliteal junction (SPJ). We assessed the impact of surgical expertise on anatomical outcome from SSV surgery and the role of preoperative duplex SPJ marking in improving outcome for vascular and non-vascular specialists. METHODS A retrospective analysis identified patients (30 limbs) who had undergone SSV surgery. These were recalled for duplex scanning of the SPJ. In a prospective study, 187 limbs had preoperative duplex marking of SPJ and postoperative duplex to assess outcome. Grade of operating surgeon was recorded in both retrospective and prospective analysis. RESULTS In both retrospective and prospective analysis, vascular specialists were significantly more likely than non-vascular specialists to correctly identify the SPJ (P < 0.0001). Preoperative SPJ marking did not improve outcome for the vascular specialist or the non-vascular specialist. CONCLUSION Preoperative SPJ marking is no substitute for surgical expertise. Competence in SSV surgery should be assessed prior to surgeons proceeding to independent practice.
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Affiliation(s)
- S Sonnenberg
- Queen Alexandra Hospital, Portsmouth Hospitals Trust, Southwick Hill Rd, Cosham, Portsmouth PO6 3LY, UK.
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23
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van Groenendael L, Flinkenflögel L, van der Vliet JA, Roovers EA, van Sterkenburg SMM, Reijnen MMPJ. Conventional surgery and endovenous laser ablation of recurrent varicose veins of the small saphenous vein: a retrospective clinical comparison and assessment of patient satisfaction. Phlebology 2010; 25:151-7. [DOI: 10.1258/phleb.2009.009044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Recurrences of varicosities of the small saphenous vein (SSV) are common. Surgical reintervention is associated with increased complication rates. The aim of the study was to assess the feasibility of endovenous laser ablation (EVLA) in recurrent varicose veins of the SSV and to compare this technique with surgical reintervention. Methods All case files of patients treated for SSV varicosities between May 2006 and October 2008 were evaluated and recurrences were selected. Demographics, duplex findings, clinical, aetiological, anatomical and pathological classification, perioperative and follow-up data were all registered. Additionally, a questionnaire focusing on patient satisfaction was taken. Results Two hundred and eighty-one patients were treated for varicosities of the SSV, of which 42 were for recurrences. Twenty-six of these were treated with EVLA, all under local anaesthesia, and 16 were surgically treated. Most surgically treated patients were treated under regional anaesthesia (88%). Technical success was achieved in 94% of surgically treated patients and in all EVLA-treated patients. Complications in both groups were mostly minor and self-limiting. Sural nerve neuralgia appeared to be more frequent in the surgically treated group (20% versus 9%). After correction for length of follow-up, the incidence of rerecurrences was not statistically significant between groups. Conclusion EVLA is feasible in patients with recurrent varicose veins of the SSV with possibly a lower incidence of sural nerve injury. Patient satisfaction is high for both treatment modalities. Studies with larger samples are indicated to confirm these observations.
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Affiliation(s)
- L van Groenendael
- Departments of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem
| | - L Flinkenflögel
- Departments of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem
| | - J A van der Vliet
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Nijmegen, Nijmegen
| | - E A Roovers
- Clinical Research Department, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - S M M van Sterkenburg
- Departments of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem
| | - M M P J Reijnen
- Departments of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem
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24
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Darvall KAL, Bate GR, Silverman SH, Adam DJ, Bradbury AW. Medium-term results of ultrasound-guided foam sclerotherapy for small saphenous varicose veins. Br J Surg 2009; 96:1268-73. [DOI: 10.1002/bjs.6755] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The results of surgery for small saphenous varicose vein (SSV) varicosities may be suboptimal in terms of recurrence and complications. The role of minimally invasive alternatives remains incompletely defined. The aim was to review the medium-term outcomes of ultrasound-guided foam sclerotherapy (UGFS) for SSV.
Methods
Eighty-six patients (92 legs) undergoing UGFS for SSV were assessed before, and 1, 6 and 12 months after treatment. Outcome measures were occlusion of, and abolition of reflux in, the SSV (technical success), absence of visible varicose veins (clinical success) and improvement in disease-specific health-related quality of life (HRQL) following treatment (Aberdeen Varicose Vein Symptom Severity Score (AVSS)).
Results
The technical and clinical success rates at 12 months were 91 and 93 per cent respectively; only three patients required a second treatment. After treatment of isolated SSV varicosities there was a significant improvement in AVSS, from a median of 19·0 (interquartile range 13·4–26·8) before treatment to 10·2 (4·0–18·3) and 9·7 (3·5–19·1) at 6 and 12 months respectively. The only complication was a popliteal vein thrombosis that required anticoagulation.
Conclusion
UGFS was an effective treatment for SSV, with abolition of reflux and visible varicose veins, and improvement in HRQL for at least 12 months.
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Affiliation(s)
- K A L Darvall
- Birmingham University Department of Vascular Surgery, Heart of England NHS Trust, Birmingham, UK
- Department of Vascular Surgery, City Hospital, Birmingham, UK
| | - G R Bate
- Birmingham University Department of Vascular Surgery, Heart of England NHS Trust, Birmingham, UK
| | - S H Silverman
- Department of Vascular Surgery, City Hospital, Birmingham, UK
| | - D J Adam
- Birmingham University Department of Vascular Surgery, Heart of England NHS Trust, Birmingham, UK
| | - A W Bradbury
- Birmingham University Department of Vascular Surgery, Heart of England NHS Trust, Birmingham, UK
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25
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Trip-Hoving M, Verheul JC, van Sterkenburg SM, de Vries WR, Reijnen MM. Endovenous Laser Therapy of the Small Saphenous Vein: Patient Satisfaction and Short-Term Results. Photomed Laser Surg 2009; 27:655-8. [DOI: 10.1089/pho.2008.2389] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Margreet Trip-Hoving
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Jorieke C. Verheul
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Steven M.M. van Sterkenburg
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Willem R. de Vries
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Michel M.P.J. Reijnen
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
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Huisman L, Bruins R, van den Berg M, Hissink R. Endovenous Laser Ablation of the Small Saphenous Vein: Prospective Analysis of 150 Patients, a Cohort Study. Eur J Vasc Endovasc Surg 2009; 38:199-202. [DOI: 10.1016/j.ejvs.2009.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
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Abstract
This article examines the practice of standard varicose vein surgery including sapheno-femoral and sapheno-popliteal ligation, perforator surgery and surgery for recurrent varicose veins. The technique of exposure of the sapheno-femoral junction and the sapheno-popliteal junction is outlined and advice given on avoidance of complications for both. The evidence regarding methods of closure over the ligated sapheno-femoral junction is examined as is the requirement for stripping and the use of different types of stripper. The requirement to strip the small saphenous vein and the extent of dissection necessary in the popliteal fossa is also examined. Complications of standard varicose vein surgery are outlined. The frequency of wound infection, nerve injury, vascular injury and venous thromboembolism are listed and strategies to avoid these complications are examined.
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Hoggan B, Cameron A, Maddern G. Systematic Review of Endovenous Laser Therapy Versus Surgery for the Treatment of Saphenous Varicose Veins. Ann Vasc Surg 2009; 23:277-87. [DOI: 10.1016/j.avsg.2008.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/06/2008] [Accepted: 11/06/2008] [Indexed: 11/17/2022]
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29
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Myers K, Jolley D. Outcome of Endovenous Laser Therapy for Saphenous Reflux and Varicose Veins: Medium-Term Results Assessed by Ultrasound Surveillance. Eur J Vasc Endovasc Surg 2009; 37:239-45. [DOI: 10.1016/j.ejvs.2008.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 09/02/2008] [Indexed: 11/16/2022]
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Nwaejike N, Srodon P, Kyriakides C. Endovenous Laser Ablation for Short Saphenous Vein Incompetence. Ann Vasc Surg 2009; 23:39-42. [DOI: 10.1016/j.avsg.2008.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 04/13/2008] [Accepted: 04/17/2008] [Indexed: 11/28/2022]
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Park SW, Hwang JJ, Yun IJ, Lee SA, Kim JS, Chang SH, Chee HK, Hong SJ, Cha IH, Kim HC. Endovenous Laser Ablation of the Incompetent Small Saphenous Vein with a 980-nm Diode Laser: Our Experience with 3Years Follow-up. Eur J Vasc Endovasc Surg 2008; 36:738-42. [PMID: 18851921 DOI: 10.1016/j.ejvs.2008.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 08/10/2008] [Indexed: 11/17/2022]
Affiliation(s)
- S W Park
- Department of Radiology, Konkuk University Hospital, Seoul, Republic of Korea
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32
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O'Hare JL, Vandenbroeck CP, Whitman B, Campbell B, Heather BP, Earnshaw JJ. A prospective evaluation of the outcome after small saphenous varicose vein surgery with one-year follow-up. J Vasc Surg 2008; 48:669-73; discussion 674. [DOI: 10.1016/j.jvs.2008.04.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Revised: 04/01/2008] [Accepted: 04/01/2008] [Indexed: 10/21/2022]
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33
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Endovenous Laser Treatment of the Small Saphenous Vein with a 980-nm Diode Laser. Dermatol Surg 2008. [DOI: 10.1097/00042728-200804000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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PARK SEUNGJOON, YIM SUBIN, CHA DAEWON, KIM SUNGCHUL, LEE SEUNGHOON. Endovenous Laser Treatment of the Small Saphenous Vein with a 980-nm Diode Laser: Early Results. Dermatol Surg 2008; 34:517-24; discussion 524. [DOI: 10.1111/j.1524-4725.2007.34097.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Scurr JRH, Scurr JH. Common Peroneal Nerve Injury during Varicose Vein Surgery. Eur J Vasc Endovasc Surg 2006; 32:334-5. [PMID: 16782365 DOI: 10.1016/j.ejvs.2006.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 04/23/2006] [Indexed: 10/24/2022]
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Myers K, Fris R, Jolley D. Treatment of varicose veins by endovenous laser therapy: assessment of results by ultrasound surveillance. Med J Aust 2006; 185:199-202. [PMID: 16922664 DOI: 10.5694/j.1326-5377.2006.tb00531.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 05/20/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the efficacy of endovenous laser therapy (EVLT) for treating varicose veins with saphenous reflux. DESIGN A trial of treatment, with results assessed by ultrasound surveillance. SETTING Outpatient clinics with sonographer and nursing support. MAIN OUTCOME MEASURES Control of reflux; occlusion or obliteration of the saphenous veins assessed by ultrasound. RESULTS EVLT was used to treat 404 veins in 308 patients. Univariate life table analysis showed primary success in 80% (95% CI, 69%-87%) and secondary success after further treatment of recurrent saphenous vein reflux by ultrasound-guided sclerotherapy in 88% (95% CI, 78%-95%) at 3 years. On multivariate Cox regression analysis, none of the covariates studied were associated with ultrasound failure. CONCLUSIONS Early results indicate that EVLT effectively controlled saphenous reflux. Its advantages are that it is performed as an outpatient procedure under local anaesthesia with immediate mobilisation, causes minimal disruption of activities, and avoids surgical trauma.
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Perrin MR, Labropoulos N, Leon LR. Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg 2006; 43:327-34; discussion 334. [PMID: 16476610 DOI: 10.1016/j.jvs.2005.10.053] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Accepted: 10/19/2005] [Indexed: 11/22/2022]
Abstract
AIM To identify in patients with recurrent varices after surgery (REVAS) the clinical, etiologic, anatomic, and pathophysiologic patterns according to the CEAP classification, as well as the site, source, causes of recurrence, and contributory factors by using the REVAS classification. METHODS Centers from eight countries enrolled patients with superficial vein reflux that had had a previous operation. A physical examination and a duplex ultrasound scan were performed at the first visit. This was repeated between 2 to 8 weeks after by the same physician and by another physician within the same time frame. The perforator, deep, and superficial veins systems as well as their accessories and tributaries were examined. A form based on the CEAP and the REVAS classification was used and the data were entered in a customized database. RESULTS Fourteen institutions enrolled 170 patients (199 lower limbs) in 1 year. Their mean age was 56 years, and 69% were women. Most of them had undergone one surgical procedure before enrollment (76.6%). Most had varicose veins and swelling (70.9%), and the rest had skin damage (29.1%). More than 90% had primary etiology. The saphenofemoral junction (47.2%) and leg perforators (54.7%) were the areas most often involved by recurrent reflux. Reflux in deep veins was detected in 27.4%. Class 2 (varicose veins) alone was present in 24.6% of limbs, two classes were present in 43%, and three in 24%. Neovascularization was as frequent as technical failure (20% vs 19%); both were seen in 17%. In 35%, the cause was uncertain or unknown. When recurrence occurred at a different site, development of reflux in new sites was found in 32% of limbs. Of the contributing factors, family history and lifestyle had the highest prevalence. Women had significantly more procedures than men, despite a clear trend toward more severe disease in the latter. CONCLUSIONS Most patients were symptomatic with several clinical forms of presentation. The REVAS classification, together with CEAP, gives significant and more appropriate information for evaluating and following-up patients with chronic venous disease who have had an intervention.
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