Endovenous laser ablation under general anesthesia for day surgery: feasibility and outcomes of the 300 patients

Technical Efficacy and Safety of Outpatient Endovenous Laser Ablation of Varicose Veins Under Local Anesthesia

Background

Endovenous Laser Ablation (EVLA) is the recommended method for treating varicose veins. It is commonly performed in an inpatient or as day surgery setting under either general or spinal anesthesia. The purpose of this study is to assess the technical efficacy and safety performing outpatient EVLA for varicose veins under local tumescent anesthesia for procedure success, complications, recovery time, and patient satisfaction.

Methods

A retrospective review of 300 consecutive patients who underwent outpatient EVLA under local tumescent anesthesia from October 2014 to June 2019 was undertaken. Patients 25-55 years diagnosed with symptomatic varicose veins and Great Saphenous Vein (GSV) incompetence were enrolled. Patient demographics, clinical characteristics, procedure duration, complications, and follow-up outcomes were recorded.

Results

A total of 331 limbs were treated. The mean procedure time was 36 minutes. Five procedures were aborted for technical reasons, resulting in an overall technical success rate of 98%. They were minor complications of bruising (13%) and phlebitis (5%), that were resolved and did not require further intervention. There were no significant complications, including deep vein thrombosis (DVT) or pulmonary embolism (PE). Patients were discharged and resumed normal activities within approximately seven days and were well satisfied.

Conclusion

EVLA for varicose veins can be performed as an outpatient procedure under local tumescent anesthesia safely and with high technical efficiency. It offers the benefits of shorter recovery times, less risk of complications, and lower health care costs.

Comparing local tumescent anesthesia and spinal anesthesia methods during and after endovenous radiofrequency ablation of great saphenous vein

BACKGROUND

Local or spinal anesthesia methods can be used during radiofrequency ablation (RFA) of the great saphenous vein. There is a gap in the literature regarding comparing and contrasting the side effects of the mentioned two methods. This study aims to retrospectively compare the spinal anesthesia method with the local tumescent anesthesia method during RFA of the great saphenous vein that also includes mini-phlebectomy.

METHODS

We retrospectively analyzed patients who underwent RFA and mini-phlebectomy divided in two groups according to the anesthesia applied method, i.e. spinal anesthesia combined with tumescent anesthesia versus local tumescent anesthesia. Pain scores, the time length of preparation interval of anesthesia and the operation time, anesthesia-related side effects such as headache, nausea-vomiting, urinary retention, quality of life scores, postoperative occlusion rates, and complications related to the intervention such as phlebitis, deep vein thrombosis (DVT) were analyzed and compared by Mann Whitney U test, Wilcoxon signed ranks test, and χ² test.

RESULTS

Between June 2015 and June 2019 a great saphenous vein RFA ablation was performed in 175 patients. A total of 103 limbs were performed under spinal anesthesia combined with tumescent anesthesia and a total of 72 limbs were performed under local tumescent anesthesia. Mini phlebectomy was applied to all patients. Pain scores of the spinal anesthesia group were lower than the other group, and there was a significant difference. There was no significant difference between the operation lengths of both groups, but the preparation phase of anesthesia was shorter in local tumescent anesthesia patients, and the difference was significant. Anesthesia related side effects such as headache, nausea-vomiting, and urinary retention showed a significant difference between the two groups, and they were lower in the local tumescent anesthesia group. Preoperative quality of life scores of both groups decreased postoperatively. The postoperative occlusion rate of group 1 was 96.1%, and group 2 was 100% at three months, but the difference was not significant. We encountered three cases of phlebitis, two cases of DVT and two cases of bruising in group 1, and one case of bruising in group 2. There was no postoperative paresis or paresthesia in either groups.

CONCLUSIONS

This monocenter and retrospective report of 175 GSV RFA using tumescent local anesthesia or spinal anesthesia combined with local tumescent anesthesia demonstrated that both methods of anesthesia are effective. Although the pain scores are better with spinal anesthesia, the local tumescent anesthesia method is more efficient, requiring a shorter time, and is associated with fewer complications such as headache, nausea-vomiting, or urinary retention and deep venous thrombosis.

Our experience regarding patients with headache, vomiting, and urinary retention following endothermal ablation of the greater saphenous vein under spinal anesthesia: Gender type, age interval, and procedural risk factors are important

OBJECTIVES

The endovenous thermal ablation of the greater saphenous vein under spinal anesthesia is still a popular technique. Although this procedure is considered to be fast and simple, side effects such as headaches, vomiting, and urinary retention could occur. These side effects make the recovery period difficult for the patient. The patient's age, gender, and procedural risk factors such as needle sizes and types are important parameters that affect the occurrence and rate of undesirable outcomes. This retrospective study aims to evaluate the endovenous thermal ablation method for the management of incompetent great saphenous veins under spinal anesthesia.

METHODS

A total of 128 patients with incompetent varicose veins who were treated with an endovenous thermal ablation method under spinal anesthesia were retrospectively investigated between January 2016 and January 2019. The pre-, intra-, post-procedural, and follow-up data of the patients were collected and retrospectively compared.

RESULTS

A total of 128 patients (69 males, 59 females; mean age 45.8 ± 11.8 years; range 21-71 years) were included in the study. The average preprocedural great saphenous vein diameters were 7.41 ± 18.8 mm (range: 5.5-13.0). The average ablated vein length was 25.3 ± 3.4 (range: 15-35) cm. The average tumescent anesthesia use was 300.9 ± 52.6 (range: 150-500) mL. The average procedure time was 18.2 ± 1.8 (range: 11-25) min. The venous clinical severity scores and the chronic venous insufficiency quality of life questionnaire scores declined significantly (p for venous clinical severity scores: 0.001, p for chronic venous insufficiency quality of life questionnaire scores: 0.001). There was no postoperative paresis or paresthesia. There was one case of deep venous thrombosis and three cases of bruising. The total of three months' occlusion rates was 96.9% (124/128).The overall post-dural puncture headache ratio was 18%. Women significantly suffered from more headaches than men (27% vs. 10%, p = 0.013). The extreme age intervals (pertaining to ages between 18 and 30 or 50⁺) were almost significantly less affected by headaches in comparison to the group with the age interval between 31 and 50 (11.3%, 24.2%, p: 0.056). A percentage of 12.5 patients suffered from vomiting. It was recorded that female patients suffered from vomiting more so than the males (20.3%, 5.8%, p: 0.013). Pertaining to vomiting, there was no significant difference between the two age interval groups (p: 0.14). Urinary retention was observed in 6.3% of the patients. The female gender had a higher ratio of urinary retention, but the difference was insignificant. (8.5%, 4.3%, p: 0.46). There was no significant difference between the age interval groups in terms of urinary retention.

CONCLUSIONS

The endovenous thermal ablation of the greater saphenous vein under spinal anesthesia is a fast and effective treatment option for the management of incompetent saphenous veins. However, side effects such as headaches, vomiting, and urinary retention that are affected by gender types, age-intervals, and procedural characteristics should be kept in mind.

Endovenous Laser Ablation with and Without Concomitant Phlebectomy for the Treatment of Varicose Veins: A Retrospective Analysis of 954 Limbs

BACKGROUND

Endovenous laser ablation (EVLA) with concomitant phlebectomy is commonly performed in many institutions. However, phlebectomy is associated with cosmetic complications such as surgical scarring, hemorrhage, and hematoma. This study aims to compare the need for additional sclerotherapy during follow-up after EVLA with and without concomitant phlebectomy.

METHODS

Between November 2013 and December 2018, we performed EVLA on 1,363 limbs in 1,009 patients with symptomatic primary varicose veins, of which 954 limbs in 771 patients with great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency were included in this study. Data were collected prospectively and supplemented with retrospective medical record review. Demographic and clinical characteristic profiles were collected. The outcomes of EVLA with or without concomitant phlebectomy were compared. Logistic regression was used to assess predictors for additional sclerotherapy after EVLA.

RESULTS

CEAP classification (P < 0.001), operative time (P < 0.001), laser device type (P < 0.001), length of the treated vein (P < 0.001), linear endovenous energy density (P < 0.001), and tumescent local anesthesia volume (P < 0.001) differed significantly. Pain after EVLA was significantly more frequent in the nonphlebectomy group than in the phlebectomy group (P = 0.005). During follow-up, 34 of 954 limbs (3.6%) underwent additional sclerotherapy for residual visible varicose veins after EVLA. No statistical difference was found in the rate of additional sclerotherapy between the groups (P = 0.849). Logistic regression showed that female sex (odds ratio [OR], 6.18; 95% confidence interval [CI], 1.86-20.6; P = 0.003) is significantly associated with additional sclerotherapy, and concomitant phlebectomy is not a significant predictor of additional sclerotherapy (OR, 0.844; 95% CI, 0.375-1.90; P = 0.682).

CONCLUSIONS

Patient preference for additional sclerotherapy was comparable between those who underwent EVLA with and without concomitant phlebectomy. This result supports our present strategy of avoiding simultaneous phlebectomy at the time of primary EVLA.

Monitored anesthesia care for great saphenous vein stripping surgery with target controlled infusion of propofol and remifentanil: a prospective study

Background

The aim of this study was to determine the appropriate target concentrations at the effect site of propofol and remifentanil when deep sedation was achieved by monitored anesthesia care (MAC) anesthesia and related respiratory depression during vein stripping surgery for varicose veins.

Methods

In total, 51 adult patients who were scheduled for varicose vein stripping surgery were sedated with propofol and remifentanil during the surgery, after administration of midazolam. Target concentrations at the effect site of the two drugs were changed based on the patient's status. Respiratory support was applied in the order of oxygen supply, chin lift, and assisted mask ventilation. Target concentrations at the effect site of propofol and remifentanil, the need for respiratory support, and a six-point rating scale satisfaction score were the outcome measurements.

Results

Only one patient did not require oxygen, eight patients needed oxygen alone, 22 patients required use of the chin lift technique, and 20 patients were assisted with mask ventilation. There was no significant difference in the target concentration of propofol or remifentanil between the patients who required mask ventilation and those who did not. Fifty of the 51 patients reported a satisfaction score of 6.

Conclusions

Although MAC using low target concentrations of propofol and remifentanil during vein stripping surgery was satisfactory to patients, close observation regarding the need for respiratory assistance was necessary.