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Vasquez MA, Di Iorio M, Worthington-Kirsch RL, Fakhoury E, Blebea J. Current practice of cyanoacrylate endovenous ablation: American vein and lymphatic society position statement. Phlebology 2024; 39:245-250. [PMID: 38082236 DOI: 10.1177/02683555231221862] [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: 04/05/2024]
Abstract
BACKGROUND Cyanoacrylate endovenous ablation and closure of incompetent saphenous veins have become increasingly utilized since its approval for use in the United States in 2015. This increase in usage necessitates a societal update to guide treatment and ensure optimal and consistent patient outcomes. METHOD The American Vein and Lymphatic Society convened an expert panel to write an updated Position Statement with explanations and recommendations for the appropriate use of cyanoacrylate endovenous ablation for patients with venous insufficiency. RESULT A Position Statement was produced by the expert panel with recommendations for appropriate use, treatment technique, outcomes review, and potential adverse events. Their recommendations were reviewed, edited, and approved by the Guidelines Committee of the Society. CONCLUSION This societal Position Statement provides a useful document for reference for physicians and venous specialists to assist in the appropriate use of cyanoacrylate endovenous ablation in the treatment of patients with venous insufficiency.
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Affiliation(s)
| | | | | | | | - John Blebea
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, MI, USA
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Chan KS, Lo ZJ, Wang Z, Bishnoi P, Ng YZ, Chew S, Chong TT, Carmody D, Ang SY, Yong E, Chan YM, Ho J, Graves N, Harding K. A prospective study on the wound healing and quality of life outcomes of patients with venous leg ulcers in Singapore-Interim analysis at 6 month follow up. Int Wound J 2023; 20:2608-2617. [PMID: 36915237 PMCID: PMC10410353 DOI: 10.1111/iwj.14132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
Venous leg ulceration results in significant morbidity. However, the majority of studies conducted are on Western populations. This study aims to evaluate the wound healing and quality of life for patients with venous leg ulcers (VLUs) in a Southeast Asian population. This is a multi-centre prospective cohort study from Nov 2019 to Nov 2021. All patients were started on 2- or 4-layer compression bandage and were reviewed weekly or fortnightly. Our outcomes were wound healing, factors predictive of wound healing and the EuroQol 5-dimensional 5-level (EQ-5D-5L) health states. Within our cohort, there were 255 patients with VLU. Mean age was 65.2 ± 11.6 years. Incidence of diabetes mellitus was 42.0%. Median duration of ulcer at baseline was 0.30 years (interquartile range 0.136-0.834). Overall, the median time to wound healing was 4.5 months (95% confidence interval [CI]: 3.77-5.43). The incidence of complete wound healing at 3- and 6-month was 47.0% and 60.9%, respectively. The duration of the wound at baseline was independently associated with worse wound healing (Hazard ratio 0.94, 95% CI: 0.89-0.99, P = .014). Patients with healed VLU had a significantly higher incidence of perfect EQ-5D-5L health states at 6 months (57.8% vs 13.8%, P < .001). We intend to present longer term results in subsequent publications.
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Affiliation(s)
- Kai Siang Chan
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | | | - Zifei Wang
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Priya Bishnoi
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Stacy Chew
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
| | - Tze Tec Chong
- Department of Vascular SurgerySingapore General HospitalSingaporeSingapore
| | - David Carmody
- Department of EndocrinologySingapore General HospitalSingaporeSingapore
| | - Shin Yuh Ang
- Nursing DivisionSingapore General HospitalSingaporeSingapore
| | - Enming Yong
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Yam Meng Chan
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Jackie Ho
- Department of Cardiac, Thoracic & Vascular SurgeryNational University HospitalSingaporeSingapore
| | - Nicholas Graves
- Health Services & Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Keith Harding
- Skin Research Institute of Singapore, Agency for ScienceTechnology and Research (A*STAR)SingaporeSingapore
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Cutler B, Kiguchi MM, Kochubey M, Dirks RC, Kliewer J, O’Banion LA. Opportunity Cost Comparison of Radiofrequency Ablation and Cyanoacrylate Adhesive Venous Closures. J Vasc Surg Venous Lymphat Disord 2022. [DOI: 10.1016/j.jvsv.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Erdinc I. Efficiency of endovenous laser and glue ablation methods in comparison with conventional surgery for the treatment of venous ulcers. Phlebology 2022; 37:670-677. [DOI: 10.1177/02683555221125384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction In this study, we aimed to investigate the efficiency of endovenous laser and glue ablation techniques and compared the results with conventional surgical stripping. Patients and Methods Between January 2005 and January 2020, among 3133 consecutive patients with superficial venous reflux disease receiving treatment at our institution, there were 112 consecutive patients with active venous ulcers. Patients were divided into 3 groups as receiving conventional open surgical treatment (Group 1, n: 70), endovenous glue ablation (Group 2, n: 20), and endovenous laser ablation (Group 3, n: 22). Comorbidity factors, duration and size of the ulcers, deep, perforating, and small saphenous vein disease detected with detailed Doppler ultrasonography, and duration for healing and recurrence were investigated. Results The age, gender, comorbidities, smoking, history of previous treatment, diameter of the small saphenous vein, number of refluxing perforating veins, size of the ulcer, and ulcer recurrence ratio were not significantly different between groups. There were 7 patients with bilateral disease and in total 119 legs were intervened. Mean durations for complete ulcer healing were significantly lower in Group 1 (53.28 ± 22.1 days) than Group 2 (73.7 ± 39.6 days); however, it did not differ significantly between Group 1 and Group 3 (62.59 ± 19.65 days), and Group 2 and Group 3 ( p: 0.26). Ulcers recurred in 23 patients (33%) in stripping group at a mean follow up of 14.42 ± 4.6 months, in 7 patients (35%) in glue ablation group at a mean follow up of 11.97 ± 2.94 months, and in 5 patients (23%) in laser ablation group at a mean follow up of 12.66 ± 3.48 months ( p > 0.05 for all). Increased body mass index, co-existence of chronic venous insufficiency, active cigarette smoking, non-compliance with physician advises and exercise and compression stockings, and depth of the ulcers were correlated with recurrence. Conclusion The rationelle beyond treatment of the venous ulcers and prevention of recurrence relies on relief of the venous hypertension by interventional methods and/or compression therapy. None of the methods is superior over the others. Healing in short term without further recurrence may be achieved with successful intervention as well as good patient compliance.
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Affiliation(s)
- Ibrahim Erdinc
- Cardiovascular Surgery Clinic, Bozyaka Education and Research Hospital, Izmir, Turkey
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Chen CW, Tseng YH, Kao CC, Ngo YG, Lee CY, Yang TY, Lin YH, Huang YK. Venous Segmental Flow Changes after Superficial Venous Intervention Demonstrating by Quantitative Phase-Contrast Magnetic Resonance Analysis: Preliminary Data from a Longitudinal Cohort Study. J Pers Med 2022; 12:jpm12061000. [PMID: 35743784 PMCID: PMC9224938 DOI: 10.3390/jpm12061000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
The effects of superficial venous intervention on hemodynamics can be quantified using two-dimensional phase-contrast magnetic resonance imaging (2D PC-MRI). Twelve patients received pre- and postintervention 2D PC-MRI analysis using quantitative hemodynamic parameters. Fifteen healthy volunteers served as controls. The 2D PC-MRI results of the target limbs (limbs scheduled for intervention for venous reflux) differed from those of the controls in terms of stroke volume (SV), forward flow volume (FFV), absolute stroke volume (ASV), and mean flux (MF) in all venous segments. The velocity time integral (VTI) and mean velocity (MV) of the popliteal vein (PV) segments were similar between the target limbs and controls preoperatively. After intervention, the target limbs exhibited an increase in VTI and MV in the femoral vein (FV) and PV segments. We compared the target and nontreated limbs of the individual patients preoperatively and postoperatively to minimalize individual bias. All QFlow parameter ratios in the FV segment increased after venous intervention (VTI, p = 0.025; MV, p = 0.024). In the PV segment, FFV and ASV increased significantly (p = 0.035 and 0.024, respectively). After interventions, the volume (FFV and ASV) of the PV segment and the efficiency (VTI and MV) of the FV segment significantly increased.
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Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
| | - Yuan-Hsi Tseng
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Chih-Chen Kao
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Hospital, MOHW, Chiayi 61363, Taiwan
| | - Yeh Giin Ngo
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Chung-Yuan Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Teng-Yao Yang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Cardiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Yu-Hui Lin
- Cardiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Yao-Kuang Huang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Hospital, MOHW, Chiayi 61363, Taiwan
- Correspondence:
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Deep vein insufficiency, not the method choice, determines the outcome of endovascular treatment in CEAP 6 patients. J Vasc Surg Venous Lymphat Disord 2021; 9:1600. [PMID: 34657672 DOI: 10.1016/j.jvsv.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022]
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O'Banion LA, Kiguchi MM. Reply. J Vasc Surg Venous Lymphat Disord 2021; 9:1600-1601. [PMID: 34657673 DOI: 10.1016/j.jvsv.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
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Lawrence PF. Journal of Vascular Surgery: Venous and Lymphatic Disorders – September 2021 Audiovisual Summary. J Vasc Surg Venous Lymphat Disord 2021. [DOI: 10.1016/j.jvsv.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bademci MS, Kocaaslan C, Bayraktar FA, Oztekin A, Aydin HB, Aydin E. Efficacy of treatment modalities for venous insufficiency patients with venous ulcers. J Vasc Surg Venous Lymphat Disord 2021; 9:1350. [PMID: 34399942 DOI: 10.1016/j.jvsv.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mehmet Senel Bademci
- Department of Cardiovascular Surgery, Medicine Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Cemal Kocaaslan
- Department of Cardiovascular Surgery, Medicine Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatih Avni Bayraktar
- Department of Cardiovascular Surgery, Medicine Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ahmet Oztekin
- Department of Cardiovascular Surgery, Medicine Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Huseyin Bilal Aydin
- Department of Cardiovascular Surgery, Medicine Faculty, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ebuzer Aydin
- Department of Cardiovascular Surgery, Medicine Faculty, Istanbul Medeniyet University, Istanbul, Turkey
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The need for perforator treatment after VenaSeal and ClosureFast endovenous saphenous vein closure in CEAP 6 patients. J Vasc Surg Venous Lymphat Disord 2021; 9:1510-1516. [PMID: 34111593 DOI: 10.1016/j.jvsv.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The authors have previously demonstrated that VenaSeal (Medtronic, Inc, Minneapolis, Minn) adhesive, compared with radiofrequency ablation (RFA, ClosureFast; Medtronic, Inc), in treatment of refluxing saphenous veins in CEAP 6 limbs, results in shorter healing times of venous ulcers. The authors hypothesize that the longer treated length possible with VenaSeal's nonthermal modality may affect the number of critical refluxing perforators contributing to the nonhealing wound. This follow-up study compares the need for follow-up treatment of perforator veins after saphenous vein treatment with either radiofrequency ablation (ClosureFast RFA) or adhesive closure (VenaSeal). METHODS A multi-institutional retrospective review of CEAP 6 patients who had closure of their saphenous veins from 2015 to 2020 was conducted. Patients who underwent follow-up treatment of perforator veins were grouped according to their method of initial management of their saphenous veins. The primary end point was incidence of a perforator procedure after ClosureFast or VenaSeal ablation. Secondary end points included sclerotherapy to facilitate wound healing. Bivariate analysis used the χ2 test, Fisher exact test, t-test, and Wilcoxon rank sum test. A P value of <.05 defined statistical significance. RESULTS There were 119 CEAP 6 patients with saphenous closure: 51 limbs treated with VenaSeal and 68 with RFA. Median follow-up was 105 days (interquartile range: 44, 208). All limbs achieved wound healing during the study period. Mean time to wound healing post index procedure was shorter for VenaSeal than RFA (72 vs 293.8 days, P > .0009), as was median time (43 vs 104 days, P = .001). More limbs treated with RFA had previous known deep vein thrombosis (29% vs 10%, P = .009), deep venous insufficiency (82% vs 51%, P = .0003), and perforator reflux (57% vs 29%, P = .002). Limbs with identified follow-up perforator reflux treated with RFA had a higher prevalence of initially treated saphenous veins with RFA compared with those treated with VenaSeal (49% vs 27%, P = .003). There was no difference between the methods of vein closure and use of concurrent sclerotherapy. CONCLUSIONS ClosureFast and VenaSeal are both effective and safe modalities of saphenous ablation, but VenaSeal treatment was associated with less perforator RFA intervention.
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