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Uthoff H, Teruzzi E, Boesch P, Hofer M, Spinedi L, Bossart S, Staub D, Keo HH. Safety and efficacy of endovenous thermal ablation for treatment of symptomatic varicose veins during summertime. VASA 2023; 52:332-341. [PMID: 37341558 DOI: 10.1024/0301-1526/a001080] [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: 06/22/2023]
Abstract
Background: Traditionally, varicose vein treatment is predominately performed during the colder seasons. However, data whether higher outdoor temperatures affect the outcome and/or complication rate of endovenous thermal ablation (ETA) for treatment of symptomatic varicose veins are missing. Patients and methods: In this observational study, the medical records of all patients who had ETA of the great saphenous vein (GSV), accessory saphenous vein (ASV), or small saphenous vein (SSV) between September 2017 and October 2020 were reviewed. Results: In total 846 ETA interventions in 679 patients with 1239 treated truncal veins and an average length of 69 cm phlebectomy were included. The highest temperature recorded on and within the first 14 days after treatment was on average 19.0°C (SD±7.2°C) with a minimum and maximum of -1°C and 35.9°C. Interventions were categorized according to the recorded temperature (<25°C n=584; 25-29.9°C n=191; and ≥30°C n=71). The occlusion rates were excellent (99-100%) across groups. Despite a significantly higher proportion of patients with obesity, personal history of superficial vein thrombosis and length of phlebectomies in the high temperature groups, no significant difference regarding days of work loss, patients' satisfaction or complications including bleeding or thromboembolic events was observed. Infections were rare (0.8%), but more frequently observed in the 25-29.9°C group (2.6%; p=0.058). No infection was observed in the ≥30°C group and pain 6 weeks after the intervention was even lower (VAS 0.5±1.0 and 0.5±1.2 vs. 0.0±0.1, p=0.008). Conclusions: Given the minimal invasive nature of ETA, our results can reassure clinicians and patients that ETA varicose vein treatment is possible and safe throughout the year, even on hot summer days. A non-significant trend to more infections was observed but was not associated with other adverse outcomes such as prolonged analgetics intake or inability to work.
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Affiliation(s)
- Heiko Uthoff
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Elisa Teruzzi
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Patricia Boesch
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Manuel Hofer
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | | | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
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Bechsgaard T, Hansen KL, Brandt A, Moshavegh R, Forman JL, Føgh P, Klitfod L, Bækgaard N, Lönn L, Jensen JA, Nielsen MB. Evaluation of Peak Reflux Velocities with Vector Flow Imaging and Spectral Doppler Ultrasound in Varicose Veins. Ultrasound Int Open 2018; 4:E91-E98. [PMID: 30276359 PMCID: PMC6162191 DOI: 10.1055/a-0643-4430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/24/2018] [Accepted: 05/17/2018] [Indexed: 10/29/2022] Open
Abstract
Purpose Spectral Doppler ultrasound (SDUS) is used for quantifying reflux in lower extremity varicose veins. The technique is angle-dependent opposed to the new angle-independent Vector Flow Imaging (VFI) method. The aim of this study was to compare peak reflux velocities obtained with VFI and SDUS in patients with chronic venous disease, i. e., pathological retrograde blood flow caused by incompetent venous valves. Materials and Methods 64 patients with chronic venous disease were scanned with VFI and SDUS in the great or the small saphenous vein, and reflux velocities were compared to three assessment tools for chronic venous disease. A flow rig was used to assess the accuracy and precision of the two methods. Results The mean peak reflux velocities differed significantly (VFI: 47.4 cm/s vs. SDUS: 62.0 cm/s, p<0.001). No difference in absolute precision (p=0.18) nor relative precision (p=0.79) was found. No correlation to disease severity, according to assessment tools, was found for peak reflux velocities obtained with either method. In vitro, VFI was more accurate but equally precise when compared to SDUS. Conclusion Both VFI and SDUS detected the pathologic retrograde flow in varicose veins but measured different reflux velocities with equal precision. VFI may play a role in evaluating venous disease in the future.
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Affiliation(s)
| | | | - Andreas Brandt
- Copenhagen University Hospital Rigshospitalet, Department of Diagnostic Radiology, 2100 Copenhagen Oe, Denmark
| | - Ramin Moshavegh
- The Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
| | - Julie Lyng Forman
- Copenhagen University, Department of Public Health Section of Biostatistics, 1014 Copenhagen K, Denmark
| | - Pia Føgh
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lotte Klitfod
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Niels Bækgaard
- Copenhagen University Hospital Rigshospitalet, Department of Vascular Surgery Herlev & Gentofte Hospital, 2900 Hellerup, Denmark
| | - Lars Lönn
- Rigshospitalet, Copenhagen, DK, Radiology, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Technical University of Denmark, Department of Electrical Engineering Center for Fast Ultrasound Imaging, 2800 Kgs. Lyngby, Denmark
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Bechsgaard T, Hansen KL, Brandt AH, Holbek S, Forman JL, Strandberg C, Lönn L, Bækgaard N, Jensen JA, Nielsen MB. Vector and Doppler Ultrasound Velocities Evaluated in a Flow Phantom and the Femoropopliteal Vein. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2477-2487. [PMID: 28750944 DOI: 10.1016/j.ultrasmedbio.2017.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
Ultrasound is used for evaluating the veins of the lower extremities. Operator and angle dependency limit spectral Doppler ultrasound (SDUS). The aim of the study was to compare peak velocity measurements in a flow phantom and the femoropopliteal vein of 20 volunteers with the angle-independent vector velocity technique vector flow imaging (VFI) and SDUS. In the flow phantom, VFI underestimated velocity (p = 0.01), with a lower accuracy of 5.5% (p = 0.01) and with no difference in precision, that is, error factor, compared with SDUS (VFI: 1.02 vs. SDUS: 1.02, p = 0.58). In vivo, VFI estimated lower velocities (femoral: p = 0.001; popliteal: p = 0.001) with no difference in precision compared with SDUS (femoral: VFI 1.09 vs. SDUS 1.14, p = 0.37; popliteal: VFI 1.13 vs. SDUS 1.06, p = 0.09). In conclusion, the precise VFI technique can be used to characterize venous hemodynamics of the lower extremities despite its underestimation of velocities.
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Affiliation(s)
- Thor Bechsgaard
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | | | - Andreas Hjelm Brandt
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Simon Holbek
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Charlotte Strandberg
- Department of Radiology, University Hospital of Copenhagen, Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Lars Lönn
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Niels Bækgaard
- Department of Vascular Surgery, University Hospital of Copenhagen, Rigshospitalet & Gentofte Hospital, Hellerup, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
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