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Parsi K, Subramaniam P, Davies AH, Gasparis A, Gloviczki P, Marston WA, Meissner M, Rogan C, van Rij A. Routine use of concurrent fluoroscopic imaging during superficial endovenous interventions: A position statement of the International Union of Phlebology (UIP), the Australasian College of Phlebology (ACP), the Australia and New Zealand Society for Vascular Surgery (ANZSVS), the American Venous Forum (AVF), the American Vein and Lymphatic Society (AVLS), the European College of Phlebology (ECoP) and the Interventional Radiology Society of Australasia (IRSA). J Vasc Surg Venous Lymphat Disord 2022; 10:1198-1200. [PMID: 35970306 DOI: 10.1016/j.jvsv.2022.07.009] [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: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022]
Abstract
International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease, and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation, radiofrequency ablation, cyanoacrylate adhesive closure, and sclerotherapy (ultrasound-guided sclerotherapy). Other imaging modalities such as venography, alone or in combination with computed tomography scan or magnetic resonance imaging, may be included in the preoperative assessment of a small and select group of patients to exclude central venous obstruction, certain deep venous pathologies, pelvic origin extrapelvic varices, and complex vascular malformations. The signatory scientific and medical societies recommend against the routine use of fluoroscopy and other radiation-based imaging in the investigation and treatment of superficial venous disease.
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Affiliation(s)
- Kurosh Parsi
- International Union of Phlebology (UIP); Australasian College of Phlebology (ACP).
| | | | - Alun H Davies
- International Union of Phlebology (UIP); European College of Phlebology (ECoP)
| | | | | | | | - Mark Meissner
- International Union of Phlebology (UIP); American Venous Forum (AVF); American Vein and Lymphatic Society (AVLS)
| | - Christopher Rogan
- Australasian College of Phlebology (ACP); Interventional Radiology Society of Australasia (IRSA)
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Parsi K, Subramaniam P, Davies AH, Gasparis A, Gloviczki P, Marston WA, Meissner M, Rogan C, van Rij A. Routine use of concurrent fluoroscopic imaging during superficial endovenous interventions: A position statement of the International Union of Phlebology, the Australasian College of Phlebology, the Australia and New Zealand Society for Vascular Surgery, the American Venous Forum, the American Vein and Lymphatic Society, the European College of Phlebology and the Interventional Radiology Society of Australasia. Phlebology 2022:2683555221112735. [PMID: 36283419 DOI: 10.1177/02683555221112735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
International evidence-based guidelines recommend preoperative duplex ultrasound mapping in the assessment of chronic venous disease, and concurrent ultrasound imaging to guide superficial endovenous interventions such as endovenous laser ablation, radiofrequency ablation, cyanoacrylate adhesive closure, and sclerotherapy (ultrasound-guided sclerotherapy). Other imaging modalities such as venography, alone or in combination with computed tomography scan or magnetic resonance imaging, may be included in the preoperative assessment of a small and select group of patients to exclude central venous obstruction, certain deep venous pathologies, pelvic origin extrapelvic varices, and complex vascular malformations. The signatory scientific and medical societies recommend against the routine use of fluoroscopy and other radiation-based imaging in the investigation and treatment of superficial venous disease.
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Affiliation(s)
- Kurosh Parsi
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
| | - Peter Subramaniam
- Australia and New Zealand Society for Vascular Surgery (ANZSVS), East Melbourne, VIC, Australia
| | - Alun H Davies
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- European College of Phlebology (ECoP), Rotterdam, The Netherlands
| | | | | | | | - Mark Meissner
- International Union of Phlebology (UIP), Chatswood, NSW, Australia
- 550809American Venous Forum (AVF), East Dundee, IL, USA
- American Vein and Lymphatic Society (AVLS), Chicago, IL, USA
| | - Christopher Rogan
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
- Interventional Radiology Society of Australasia (IRSA), Ultimo, NSW, Australia
| | - Andre van Rij
- Australasian College of Phlebology (ACP), Chatswood, NSW, Australia
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Hwang K, Park SW, Hwang JH, Kwon YW, Min J, Jang H, Chang IS, Kim KW. Hydrophilic guidewire usage under ultrasound guidance in facilitating catheter advancement during endovenous treatment of incompetent great saphenous veins. Ann Surg Treat Res 2022; 102:117-124. [PMID: 35198515 PMCID: PMC8831093 DOI: 10.4174/astr.2022.102.2.117] [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: 10/12/2021] [Revised: 12/22/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study was performed To investigate the use of hydrophilic guidewires for facilitating catheter advancement during varicose vein treatment using radiofrequency ablation (RFA) or cyanoacrylate closure (CAC). Methods From March 2016 to April 2019, 463 limbs of 285 with incompetent great saphenous veins were subjected to RFA (321 limbs of 197 patients) or CAC (142 limbs of 88 patients). Procedure records were reviewed for the use of a hydrophilic guidewire, reason for the guidewire usage, and diameter of the guidewire. Results A hydrophilic guidewire was used to facilitate catheter advancement to treat 92 of 463 limbs (19.9%). For RFA, a guidewire was used to treat 53 of 321 limbs (16.5%). Among them, 15 limbs (28.3%) had vasospasm, and 38 limbs (71.7%) had venous tortuosity. For CAC, guidewire was used for 39 of 142 limbs (27.5%). Among them, 10 limbs (25.6%) had vasospasm, 23 limbs (59.0%) had venous tortuosity, and 6 limbs (15.4%) had repeated engagement of a J-tip guidewire into the varicose tributaries. In CAC, the frequency of hydrophilic guidewire usage was higher than that in RFA (P = 0.006). All varicose vein treatment sessions were technically successful. Conclusion Hydrophilic guidewire usage could facilitate catheter advancement when hindered by vasospasm, tortuosity of the saphenous vein, or repeated engagement into the varicose tributaries.
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Affiliation(s)
- Kyosoo Hwang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Wonn Kwon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jeeyoung Min
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyemin Jang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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AlGhofili HH, Aljasser AA, Alyahya IA, Almohsen HA, Alwabel SA, Alhumaid AA, Iqbal K, Altuwaijri TA, Altoijry A. Endothermal heat-induced thrombosis after endovenous laser ablation: A single-center experience. Semin Vasc Surg 2020; 32:89-93. [DOI: 10.1053/j.semvascsurg.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bittles M, Jodeh DS, Mayer JLR, Gallant M, Rottgers SA. Laser ablation of embryonic veins in children. Pediatr Int 2019; 61:358-363. [PMID: 30742735 DOI: 10.1111/ped.13804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/29/2018] [Accepted: 02/07/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Trenaunay syndrome (KTS) and related overgrowth syndromes are rare conditions that often present to academic pediatric units and multidisciplinary vascular anomaly clinics. These conditions are commonly associated with abnormalities of the superficial and deep venous structures and carry an increased risk of venous thromboembolism. METHODS A retrospective chart review was completed of all patients treated at Johns Hopkins All Children's Hospital with endovenous laser ablation therapy (EVLT) for management of dilated embryonic veins in the setting of limb overgrowth. RESULTS Three patients with limb overgrowth underwent EVLT between 2015 and 2017. All patients had successful occlusion of the targeted veins on post-procedure imaging. One patient developed a cellulitis successfully treated with oral antibiotics. CONCLUSIONS Endovenous laser ablation therapy is a well-tolerated and safe procedure for prophylactic closure of abnormal superficial embryonic veins. This study supports the use of this technique in managing increased thromboembolic risk in this unique patient population and recognizes the need for a long-term study to determine its efficacy.
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Affiliation(s)
- Mark Bittles
- Department of Radiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jennifer L R Mayer
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Michael Gallant
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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Endovenous Laser Ablation for Incompetent Saphenous Vein Combined With Fluoroscopy-Guided Endovenous Foam Sclerotherapy in Varicose Tributaries: Long-Term Follow-up Results. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00285.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to describe the long-term results of 980-nm endovenous laser ablation (EVLA) combined with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter into varicose tributaries. This report reviewed experiences with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter followed by EVLA, from July 2005 to November 2007. The sclerosing foam was injected through the microcatheter using 1% polidocanol or sodium tetradecyl sulfate. Patients were evaluated clinically and with duplex ultrasound from 1 week to 3 years to assess treatment efficacy and adverse reactions. Technical success was seen in 460 of 461 limbs (99.8%). Continued closure of the saphenous veins and complete sclerosis of varicose tributaries were noted in 351 of 408 limbs (86%) at 1-month follow-up, all 328 limbs at 3-month follow-up, all 299 limbs at 6-month follow-up, all 146 limbs at 1-year follow-up, all 94 limbs at 2-year follow-up, and all 32 limbs at 3-year follow-up. No serious complications were noted. Bruising was noted in 79.0%, and pain or tightness was noted in 68.4%. Hyperpigmentation was noted in 54.2%. EVLA for incompetent saphenous vein combined with endovenous foam sclerotherapy appears to offer the obvious benefits of less additional percutaneous sclerotherapy. However, many problems, like long-lasting pain and hyperpigmentation, can lessen the value of this procedure.
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Kim JS, Park SW, Yun IJ, Hwang JJ, Lee SA, Chee HK, Hwang JH. Retrograde Endovenous Laser Ablation through Saphenopopliteal Junctional Area for Incompetent Small Saphenous Vein: Comparison with Antegrade Approach. Korean J Radiol 2016; 17:364-9. [PMID: 27134525 PMCID: PMC4842856 DOI: 10.3348/kjr.2016.17.3.364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/02/2016] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the safety and efficacy of retrograde endovenous laser ablation (EVLA) and to compare it with the conventional antegrade EVLA for incompetent small saphenous vein (SSV). Materials and Methods Small saphenous vein was cannulated via two approaches under ultrasound-guidance. One method involved puncturing the SSV cranially at mid-calf (the antegrade group). If the antegrade puncture into the SSV failed twice, the other approach for puncture was selected that involved puncturing the SSV toward the ankle (the retrograde group). Patients were evaluated in terms of technical & clinical success, closure rates of the SSV, and complications including pain, bruising, or paresthesia at all follow-up visits. Results The 1470 nm endovenous laser was used in all limbs. Technical success was seen in all limbs in both groups (100%). Closure rate in both groups showed about 95%, without significant difference (p = 0.685). Similar linear endovenous energy density was supplied during the EVLA in both groups (p = 0.876). Three frequent complications including bruising, pain, and paresthesia did not show statistical significance between groups (p = 0.465, 0.823, 1.000, respectively). Major complications were absent in both groups. Conclusion The EVLA for the incompetent SSV using a retrograde approach is safe and effective and should be considered the alternative method if the antegrade access fails due to vasospasm or small SSV diameter.
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Affiliation(s)
- Jun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Ik Jin Yun
- Department of Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jae Joon Hwang
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Song Am Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jin Ho Hwang
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea
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Liu JJ, Fan LH, Xu DC, Li X, Dong ZH, Fu WG. The endovenous laser treatment for patients with varicose veins. Pak J Med Sci 2016; 32:55-8. [PMID: 27022345 PMCID: PMC4795889 DOI: 10.12669/pjms.321.8610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the clinical effect of endovenous laser treatment (EVLT) for patients with varicose veins. METHODS Our series included 117 patients who underwent EVLT combined with high ligation and stripping since the introduction of the technique in our institution. All EVLT procedures were performed with local skin cooling to prevent skin burns, as well as stripping after exsanguinations to prevent thrombotic phlebitis. RESULTS A total of 146 limbs in 117 patients were ablated by EVLT. Bilateral EVLT was performed in 29 patients, with the remaining 88 patients undergoing unilateral EVLT. The mean age of the patients was 57 years ± 12 years (range: 21 years to 80 years), and 56 were male and 61 were female. Follow-up for all patients lasted three to six months. The most common complication was induration and swelling, which was observed in 64 patients, followed by paraesthesia in 27, and skin burns in 12. CONCLUSION The treatment with endovenous laser treatment for patients with varicose veins is safe and effective.
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Affiliation(s)
- Jian-Jun Liu
- Jian-Jun Liu, Department of Vascular Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai 201700, China
| | - Long-Hua Fan
- Long-Hua Fan, Department of Vascular Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai 201700, China
| | - De-Chun Xu
- De-Chun Xu, Department of Vascular Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai 201700, China
| | - Xu Li
- Xu Li, Department of Vascular Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, Shanghai 201700, China
| | - Zhi-Hui Dong
- Zhi-Hui Dong, Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Wei-Guo Fu
- Wei-Guo Fu, Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China
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Joh JH, Kim WS, Jung IM, Park KH, Lee T, Kang JM. Consensus for the Treatment of Varicose Vein with Radiofrequency Ablation. Vasc Specialist Int 2014. [PMID: 26217628 PMCID: PMC4480318 DOI: 10.5758/vsi.2014.30.4.105] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2–20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis ≥class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles’ ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
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Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Woo-Shik Kim
- Department of Cardiothoracic Surgery, National Medical Center, Seoul
| | - In Mok Jung
- Department of Surgery, SVU-SMG Boramae Medical Center, Seoul
| | - Ki-Hyuk Park
- Department of Surgery, Daegu Catholic University Medical Center, Daegu
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Jin Mo Kang
- Department of Vascular Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Atasoy MM, Gümüş B, Caymaz I, Oğuzkurt L. Targeted endovenous treatment of Giacomini vein insufficiency-associated varicose disease: considering the reflux patterns. Diagn Interv Radiol 2014; 20:481-6. [PMID: 25205026 DOI: 10.5152/dir.2014.14148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the technical feasibility of targeted endovenous treatment of Giacomini vein insufficiency (GVI)-associated varicose disease and report our early results. METHODS We retrospectively screened 335 patients with varicose disease who underwent endovenous laser ablation from September 2011 to January 2013, and determined 17 patients who underwent Giacomini vein ablation. Using a targeted endovenous treatment approach considering the reflux pattern, all healthy great saphenous veins (GSV) or vein segments were preserved while all insufficient veins (Giacomini vein, perforator veins, small saphenous vein, anterior accessory GSV, major tributary veins, or incompetent segments of the GSV) were ablated. Treatment success was analysed using Doppler findings and clinical assessment scores before and after treatment. RESULTS Targeted endovenous treatment was technically successful in all cases. Seven GSVs were preserved totally and three GSVs were preserved partially (10/17, 58%), with no major complications. Clinical assessment scores and Doppler findings were improved in all cases. CONCLUSION Targeted endovenous treatment of GVI-associated varicose disease is safe and effective. In majority of GVI cases saphenous vein can be preserved using this approach.
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Affiliation(s)
- Mehmet Mahir Atasoy
- Department of Radiology, Maltepe University School of Medicine, Istanbul, Turkey.
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Park SW, Yun IJ, Hwang JJ, Lee SA, Kim JS, Chee HK, Chang IS. Fluoroscopy-guided endovenous sclerotherapy using a microcatheter prior to endovenous laser ablation: comparison between liquid and foam sclerotherapy for varicose tributaries. Korean J Radiol 2014; 15:481-7. [PMID: 25053908 PMCID: PMC4105811 DOI: 10.3348/kjr.2014.15.4.481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/15/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries. MATERIALS AND METHODS From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits. RESULTS A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found. CONCLUSION Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.
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Affiliation(s)
- Sang Woo Park
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Ik Jin Yun
- Department of Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Jae Joon Hwang
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Song Am Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Jun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea
| | - Il Soo Chang
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-729, Korea
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Willenberg T, Smith PC, Shepherd A, Davies AH. Visual disturbance following sclerotherapy for varicose veins, reticular veins and telangiectasias: a systematic literature review. Phlebology 2014; 28:123-31. [PMID: 23761921 DOI: 10.1258/phleb.2012.012051] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to review the literature reporting visual disturbance (VD)following sclerotherapy for varicose veins. Underlying mechanisms will be discussed. A literature search of the databases Medline and Google Scholar was performed. Original articles including randomized trials, case series and case reports reporting VD in humans following sclerotherapy for varicose veins were included. Additional references were also obtained if they had been referenced in related publications. The search yielded 4948 results of which 25 reports were found to meet the inclusion criteria. In larger series with at least 500 included patients the prevalence of VD following sclerotherapy ranges from 0.09% to 2%. In most reports foam sclerotherapy was associated with VD (19); exclusive use of liquid sclerosant was reported in two cases, some reports included foam and liquid sclerosant (4). There were no persistent visual disorders reported. VD occurred with polidocanol and sodium tetradecyl sulphate in different concentrations (0.25–3%). Various forms of foam preparation including various ways of foam production and the liquid –air ratio (1 or 2 parts of liquid mixed with 3, 4 or 5 parts of air) were reported in association with the occurrence of VD. VDs following sclerotherapy for varicose veins are rare and all reported events were transient. Bubble embolism or any kind of embolism seems unlikely to be the only underlying mechanism. A systemic inflammatory response following sclerotherapy has been suggested. Further research to clarify the mechanism of action of sclerosants is required.
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Affiliation(s)
- T Willenberg
- Academic Section of Vascular Surgery Imperial College School of Medicine Charing Cross Hospital, London, UK
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Perosi NA, Johnson MG, Berkmen T. Fluoroscopic-guided approaches to radiofrequency vein ablation. J Vasc Interv Radiol 2012. [PMID: 23182940 DOI: 10.1016/j.jvir.2012.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Ultrasound-guided antegrade access during endovenous lower-extremity vein ablation may be problematic. This study describes fluoroscopic-guided retrograde access to the target veins in cases in which antegrade access proved unfeasible. MATERIALS AND METHODS The retrograde technique was used to treat a total of 38 legs in 33 patients in whom antegrade access failed. This approach was selected because of small caliber or spasm of the proximal (ie, lower) great saphenous vein (GSV; n = 22), proximal (ie, lower) GSV spasm during access (n = 2), previous incomplete vein ablation (n = 7), skin disease over the proximal GSV (n = 6), and tortuous proximal GSV anatomy (n = 1). Thirty-two legs were treated with an ipsilateral retrograde approach and six were treated with a contralateral retrograde approach. Radiofrequency ablation with or without sclerotherapy was then performed. RESULTS The technical success rate for retrograde access and subsequent ablation was 100%. No procedural complications occurred. At 1 month, five patients with active ulcers exhibited ulcer healing (100%). CONCLUSIONS The fluoroscopic retrograde approach can be used to treat GSV reflux when traditional antegrade access is not feasible.
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Affiliation(s)
- Nicholas A Perosi
- Department of Diagnostic and Interventional Radiology, Yale New Haven Hospital, Saint Raphael Campus, New Haven, CT 06511, USA.
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Rathbun S, Norris A, Stoner J. Efficacy and safety of endovenous foam sclerotherapy: meta-analysis for treatment of venous disorders. Phlebology 2012; 27:105-17. [DOI: 10.1258/phleb.2011.011111] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Aim Endovenous foam sclerotherapy (EFS) is used widely throughout the USA for the treatment of venous disorders. The purpose of the quantitative meta-analysis was to systematically and comprehensively evaluate the literature to provide accurate estimates of safety and efficacy outcomes for this procedure. Methods A comprehensive electronic search of published literature in several databases was performed using a wide variety of MESH headings. In addition, meeting abstracts and bibliographies of selected references were reviewed for eligible papers. Two reviewers abstracted selected treatment-related data. Results Of 684 identified manuscripts and abstracts reviewed, 104 papers were abstracted and analysed. More than 50% were published between 2004 and 2008. EFS was found to be effective with similar vein occlusion rates to laser therapy, but less effective than surgery. In addition, major adverse effects were rare. Conclusions EFS is a safe and effective therapy for the treatment of venous disorders.
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Affiliation(s)
- S Rathbun
- Cardiovascular Section, College of Medicine
| | - A Norris
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - J Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Sarvananthan T, Shepherd AC, Willenberg T, Davies AH. Neurological complications of sclerotherapy for varicose veins. J Vasc Surg 2012; 55:243-51. [DOI: 10.1016/j.jvs.2011.05.093] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 05/23/2011] [Accepted: 05/24/2011] [Indexed: 01/19/2023]
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Endovenous Laser Ablation and Concomitant Foam Sclerotherapy: Experience in 504 Patients. Cardiovasc Intervent Radiol 2011; 35:1403-7. [DOI: 10.1007/s00270-011-0329-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/13/2011] [Indexed: 10/14/2022]
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Park SW, Lee SA, Hwang JJ, Yun IJ, Kim JS, Chang SH, Chee HK, Chang IS. Early results of endovenous ablation with a 980-nm diode laser for an incompetent vein of Giacomini. Korean J Radiol 2011; 12:481-6. [PMID: 21852909 PMCID: PMC3150676 DOI: 10.3348/kjr.2011.12.4.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/25/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We wanted to evaluate the effectiveness of endovenous ablation of the incompetent vein of Giacomini using a 980-nm diode laser. MATERIALS AND METHODS A total of 18 patients (18 limbs, 4%) had the incompetent vein of Giacomini. Retrograde reflux originating from the great saphenous vein was noted in sixteen limbs and paradoxical diastolic anterograde reflux from the saphenopopliteal junction was observed in two limbs. After tumescent anesthesia, laser ablation using a 980-nm wavelength laser fiber was performed under ultrasound and/or fluoroscopic guidance. Patients were evaluated clinically and with duplex ultrasound at one week and at one, three, six and twelve months after laser ablation for the technical and clinical success. RESULTS In the 18 limbs, the technical success rate was 100%. Continued closure of the vein of Giacomini was seen in 18 of 18 limbs after one month, in 12 of 12 limbs after three and six months and in six of six limbs after twelve months. No recanalization of the vein and no major complications occurred. CONCLUSION Endovenous laser ablation with a 980-nm wavelength is an effective and safe procedure for treating an incompetent vein of Giacomini.
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Affiliation(s)
- Sang Woo Park
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, Korea
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