A comparison of thermal and non-thermal ablation

Demographic and clinical characteristics of patients with varicose veins in Albania: a retrospective, single-centre analysis

Introduction

Chronic venous disease (CVD) constitutes a frequently underdiagnosed pathological condition that progressively diminishes patients' quality of life and imposes an escalating strain on healthcare resources. This study aims to comprehensively investigate the epidemiological landscape of varicose vein disease, examining age group distributions, gender patterns, residence influences, marital status correlations, weight considerations, educational impacts, and various aspects related to varicose veins.

Material and methods

This was a single-centre retrospective analysis, in Albania from May 2018 to September 2023. Data were collected retrospectively through hospital records. Data collection involved administering a structured questionnaire to study participants, categorically organised into three sections. The first section focused on collecting demographic information, the second section involved self-perception of identifying risk factors associated with varicose veins, and the final section included inquiries about the history of variceal surgery.

Results

The CEAP classification distribution in our cohort revealed a predominant presence of C2 (varicose veins) in 53.3% of patients, followed by C3 (oedema) at 29.2%, and C4 (changes in skin and subcutaneous tissue secondary to CVD) at 10.5%, whereas C5 (healed venous ulcer) and C6 (active venous ulcer) were less frequent. Based on the body mass index (BMI) scale, data from patients indicated that 9.7% were in the category of underweight, 54.8% had a normal BMI, and 35.5% were categorised as overweight.

Conclusions

The study's thorough exploration of patient perspectives, risk factors, and treatment choices contributes to a holistic understanding of varicose vein management, emphasising the importance of personalised approaches that account for demographic variations and individual beliefs.

Comparing the Effects of Radial and Jacketed Laser Tip Fibers on Outcome of Endovenous Laser Ablation of Lower Limb Truncal Venous Reflux

BACKGROUND

Saphenous vein reflux is one of the leading causes of cosmetic and functional disabilities. The recent European Society of Vascular Surgery guidelines recommend endovenous thermal ablation over surgery or sclerotherapy for the treatment of great saphenous vein (GSV) reflux in patients with chronic venous disease. The aim of this study is to compare different laser fiber tip configurations to outcome regarding technical success and incidence of complications.

DESIGN

A retrospective analysis conducted on patients with documented GSV reflux from 2020 to 2022, comparing baseline parameters and outcome between 2 groups of laser tip fibers used; radial tip and jacketed tip. Primary end point was technical success. Secondary endpoints included incidence of complications in each group, and VCSS score difference in both groups.

METHODS

Inclusion criteria entailed patients with primary varicose veins over the age of 18 years, free from malignancy, hematological disorders, and having documented GSV reflux of more than 0.5 sec. All patients had endovenous laser ablation (EVLA) of the GSV, with complementary foam sclerotherapy or ambulatory phlebectomies as required.

RESULTS

A total of 74 patients underwent EVLA (85 limbs). Fifty-four were done using the radial laser fibers, and 32 using jacketed fibers. Technical success was achieved in 78 limbs (92.9%), 6 limbs (7.1%) had recanalization of the proximal 3 cm of the GSV at 1 month, 2 patients experienced hematomas, and 5 patients had superficial vein thrombosis. There was no significant association between postoperative pain, bruising, recanalization, hematoma formation, and superficial vein thrombosis with different laser fiber tip configurations (P-value 0.95, 0.6, 0.18, 1, and 1, respectively), nor was there any significant difference in VCSS between them (P-value 0.14).Technical success was 90% in the jacketed fibers and 94.1% in the radial fibers group (P-value 0.18).

CONCLUSIONS

Neither does laser fiber tip configuration nor its make have a significance on outcome of EVLA of GSV reflux. Both radial and jacketed laser fiber tips exhibit similar safety and efficacy in EVLA.

Chronic venous insufficiency: a comprehensive review of management

Chronic venous insufficiency is an extensive progressive disease in need of public health attention. This insidious disease is a growing burden on patient quality of life and the health economy. Chronic venous insufficiency has become more pronounced in global populations, especially in regions exhibiting a higher rate of risk factors. It is critical for healthcare providers to recognise and intervene early to prevent ongoing and debilitating complications. This article provides a comprehensive review of chronic venous insufficiency outlining the anatomy, pathophysiology, clinical presentation, assessment and management options.

Mechanochemical ablation as an alternative to venous ulcer healing compared with thermal ablation

OBJECTIVE

We aimed to compare mechanochemical ablation (MOCA) and thermal ablation (radiofrequency ablation and endovenous laser therapy) for venous ulcer healing in patients with clinical class 6 chronic venous insufficiency.

METHODS

Electronic medical records were reviewed of patients with venous ulcers who underwent truncal or perforator ablation between February 2012 and November 2015. These records contained history of venous disease and ulcer history, procedures, complications, follow-up, method of wound care, and current status of the ulcer. The patients were grouped according to the method of ablation for comparison.

RESULTS

In 66 patients, 82 venous segments were treated, 29 with thermal methods and 53 with MOCA; 16% of patients had prior venous intervention. Before ablation, three patients in the thermal group had a history of deep venous thrombosis compared with seven in the MOCA group. On average, patients treated with MOCA were older (thermal ablation, 57.2 years; MOCA, 67.9 years; P = .0003). Ulcer duration before intervention ranged from 9.2 months for thermal ablation to 11.2 months for MOCA (P = NS). In total, 74% of patients treated with MOCA healed their ulcers compared with 35% of those treated with thermal ablation (P = .01). A healed ulcer was defined as elimination of ulcer depth and superficial skin coverage. The mean time to heal was 4.4 months in the thermal ablation group compared with 2.3 months with MOCA (P = .01). The mean length of follow-up was 12.8 months after thermal ablation and 7.9 months after MOCA (P = .02). Both age (P = .03) and treatment modality (P = .03) independently had an impact on ulcer healing on multiple logistic regression analysis. All but two patients were treated with an Unna boot after venous ablation. Complications included readmission of two patients with nonaccess-related infections, one nonocclusive deep venous thrombosis, and one late death unrelated to the procedure second to pneumonia in the setting of advanced colon cancer. There were three recurrent ulcers at 1 week, 2 months, and 7 months after MOCA that rehealed with Unna boot therapy and continued compression.

CONCLUSIONS

MOCA is safe and effective in treating chronic venous ulcers and appears to provide comparable results to methods that rely on thermal ablation. Younger age and use of MOCA favored wound healing. MOCA was an independent predictor of ulcer healing. Randomized studies are necessary to further support our findings.

Systematic review and meta-analysis of endovenous cyanoacrylate adhesive ablation for incompetent saphenous veins

OBJECTIVE

The objective of this study was to assess the effectiveness, safety, and quality of care afforded by cyanoacrylate ablation (CA) vs existing options in treating great saphenous vein incompetence.

METHODS

We conducted a systematic review; used the Grading of Recommendations Assessment, Development, and Evaluation framework; assessed the quality of randomized clinical trials using the Cochrane risk of bias tool; and performed a meta-analysis on the available comparative measurements.

RESULTS

Three comparative studies, two randomized controlled trials and one observational study comprising 1057 participants, were included for effectiveness assessment purposes. The safety assessment also included 10 case series. Available evidence allowed comparison of CA with radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) but not with other treatments. The comparative effectiveness analysis showed that whereas all three treatments reduced disease severity, none was significantly better than any other in terms of effectiveness. In terms of safety, however, CA devices gave rise to fewer adverse events and less severity at 12 months of follow-up than did EVLA or RFA. Other important advantages of CA over EVLA or RFA were linked to quality of care; patients reported less pain during intervention with CA than with RFA or EVLA devices and registered shorter intervention and recovery times. Furthermore, tumescent anesthesia and compression bandages were not necessary, making this technique more comfortable for the patients than endothermal techniques.

CONCLUSIONS

Compared with EVLA and RFA, CA treatments yield comparable effectiveness outcomes and lead to less frequent and fewer mild adverse events, without difference in major adverse events. Furthermore, CA devices have advantages in terms of quality of care indicators, such as pain during intervention, treatment and recovery times, lower use of anesthesia, and zero use of compression bandages after treatment.