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Juhani AA, Abdullah A, Alyaseen EM, Dobel AA, Albashri JS, Alalmaei OM, Salem Alanazi YM, Almutairi DR, Alqahtani LN, Alanazi SA. Interventions for great saphenous vein insufficiency: A systematic review and network meta-analysis. Vascular 2024:17085381241273098. [PMID: 39148483 DOI: 10.1177/17085381241273098] [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: 08/17/2024]
Abstract
BACKGROUND Great saphenous vein insufficiency (GSVI) adversely affects the quality of life of affected individuals. Minimally invasive endo-venous ablation techniques have emerged as effective and safe treatments, despite the longstanding use of surgical interventions. We aim in our study to evaluate all the available interventions in the literature, either endo-venous or conventional approaches for the treatment of GSVI. METHODS A thorough search was performed across four electronic databases to identify relevant studies. A frequentist network meta-analysis (NWM) was executed on the combined data to derive network estimates pertaining to the outcomes of concern. Risk ratios (RRs) were employed as the effect size metric for binary outcomes, while mean differences (MDs) were utilized for continuous outcomes, each reported with a 95% confidence interval. The qualitative review was conducted employing the Cochrane risk of bias assessment tool 1. RESULTS Our NWM included 75 studies encompassing 12,196 patients. Regarding technical success rate within the first 5 years after treatment, Endo-venous Laser Ablation (EVLA) with High Ligation and Stripping (HL/S), EVLA alone, Cyanoacrylate Adhesive Injection, cryostripping, HL/S and Radiofrequency Ablation (RFA) were significantly better than Ultrasound-Guided Foam Sclerotherapy and F-care. Also, invagination stripping was inferior to all interventions. Conservative Hemodynamic Cure for Venous Insufficiency and Varicose Veins (CHIVA) demonstrated a significantly lower recurrence rate with a RR of 0.35 [0.15; 0.79] compared to RFA, but RFA was more effective in recurrence prevention than HL/S and Mechanochemical Ablation (MOCA), with a RR of 0.63 [0.41; 0.97] and 0.18 [0.03; 0.95], respectively. Endo-venous Steam Ablation (EVSA) emerged as the most effective in reducing post-intervention pain, showing a MD of -2.73 [-3.72; -1.74] compared to HL/S. In Aberdeen Varicose Vein Questionnaire outcome, our analysis favored MOCA over most studied interventions, with an MD of -6.88 [-12.43; -1.32] compared to HL/S. Safety outcomes did not significantly differ among interventions. CONCLUSION Our findings revealed significant variations in the technical success rates, recurrence rates, and post-intervention pain levels among different interventions. CHIVA exhibited enhanced performance in terms of lower recurrence rates, while EVSA emerged as a promising choice for mitigating post-intervention pain. Additionally, our analysis underscored the significance of patient-reported outcomes, with MOCA consistently yielding favorable results in terms of enhancing quality of life and expediting the return to regular activities.
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Affiliation(s)
- Abdulkreem Aa Juhani
- Faculty of medicine and surgery,.King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Abdullah Abdullah
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Amnah A Dobel
- College of Medicine, Taif University, Taif, Saudi Arabia
| | | | - Osama M Alalmaei
- College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Pinto Rodríguez P, Fassler M, Obi A, Osborne NH, Robinson ST, Jacobs BN, Aziz F, Nguyen KP, Gwozdz AM, Rodriguez LE, Fukaya E, Sachdev U, Iyad Ochoa Chaar C. Factors associated with lack of clinical improvement after vein ablation in the vascular quality initiative. J Vasc Surg Venous Lymphat Disord 2024; 12:101884. [PMID: 38552954 DOI: 10.1016/j.jvsv.2024.101884] [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] [Received: 11/14/2023] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Insurance companies have adopted variable and inconsistent approval criteria for chronic venous disease (CVD) treatment. Although vein ablation (VA) is accepted as the standard of care for venous ulcers, the treatment criteria for patients with milder forms of CVD remain controversial. This study aims to identify factors associated with a lack of clinical improvement (LCI) in patients with less severe CVD without ulceration undergoing VA to improve patient selection for treatment. METHODS We performed a retrospective analysis of patients undergoing VA for CEAP C2 to C4 disease in the Vascular Quality Initiative varicose veins database from 2014 to 2023. Patients who required intervention in multiple veins, had undergone prior interventions, or presented with CEAP C5 to C6 disease were excluded. The difference (Δ) in venous clinical severity score (VCSS; VCSS before minus after the procedure) was used to categorize the patients. Patients with a ΔVCSS of ≤0 were defined as having LCI after VA, and patients with ≥1 point decrease in the VCSS after VA (ΔVCSS ≥1) as having some benefit from the procedure and, therefore, "clinical improvement." The characteristics of both groups were compared, and multivariable regression analysis was performed to identify factors independently associated with LCI. A second analysis was performed based on the VVSymQ instrument, which measures patient-reported outcomes using five specific symptoms (ie, heaviness, achiness, swelling, throbbing pain, and itching). Patients with LCI showed no improvement in any of the five symptoms, and those with clinical improvement had a decrease in severity of at least one symptom. RESULTS A total of 3544 patients underwent initial treatment of CVD with a single VA. Of the 3544 patients, 2607 had VCSSs available before and after VA, and 420 (16.1%) had LCI based on the ΔVCSS. Patients with LCI were more likely to be significantly older and African American and have CEAP C2 disease compared with patients with clinical improvement. Patients with clinical improvement were more likely to have reported using compression stockings before treatment. The vein diameters were not different between the two groups. The incidence of complications was overall low, with minor differences between the two groups. However, the patients with LCI were significantly more likely to have symptoms after intervention than those with improvement. Patients with LCI were more likely to have technical failure, defined as vein recanalization. On multivariable regression, age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02) and obesity (OR, 1.47; 95% CI, 1.09-2.00) were independently associated with LCI, as was treatment of less severe disease (CEAP C2; OR, 1.82; 95% CI, 1.30-2.56) compared with more advanced disease (C4). The lack of compression therapy before intervention was also associated with LCI (OR, 6.05; 95% CI, 4.30-8.56). The analysis based on the VVSymQ showed similar results. CONCLUSIONS LCI after VA is associated with treating patients with a lower CEAP class (C2 vs C4) and a lack of compression therapy before intervention. Importantly, no significant association between vein size and clinical improvement was observed.
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Affiliation(s)
- Paula Pinto Rodríguez
- Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT.
| | - Michael Fassler
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Andrea Obi
- Division of Vascular Surgery, University of Michigan, Ann Arbor, MI
| | | | - Scott T Robinson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Benjamin N Jacobs
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Faisal Aziz
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA
| | - Khanh P Nguyen
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Adam M Gwozdz
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | | | - Eri Fukaya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA
| | - Ulka Sachdev
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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3
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Zheng G, Xie H, Lai M, Qin B, Liu X. Comparison of two ablation procedures combined with high ligation and foam sclerotherapy and compression therapy for patients with venous leg ulcers. Postgrad Med 2024; 136:514-522. [PMID: 38861319 DOI: 10.1080/00325481.2024.2366155] [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] [Received: 01/11/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
AIM To compare the ablation techniques' efficacy of endovenous microwave ablation (EMA) combined with high ligation (HL), foam sclerotherapy (FS) and compression therapy (CT) and endovenous laser ablation (EVLA) combined with HL-FS-CT in the treatment of VLUs. METHOD 301 consecutive patients with VLUs from 2013 to 2022 in a 3200-bed hospital were intervened by EMA combined with HL-FS-CT and EVLA combined with HL-FS-CT were retrospectively compared. RESULTS One hundred thirty-four patients underwent EMA+HL-FS-CT and 167 patients underwent EVLA+HL-FS-CT. The primary outcome of the ulcer healing time was 1.45(0.75-1.5) months and 1.86(0.5-2.5) months, respectively, in the two groups (HR for ulcer healing was 1.26, 95% CI [0.96-1.66], p = 0.097). Secondary outcomes included that no significant difference was found in ulcer recurrence and GSV recanalization and complications between the two groups, and the postoperative VCSS and AVVQ were significantly lower than the baseline values in the respective groups (p = 0.0001). CONCLUSION EMA+HL-FS-CT and EVLA+HL-FS-CT are both effective at treating VLUs. Both of the two comprehensive treatments were beneficial to the healing of ulcers, but no evidence showed which one was superior in the ulcer healing time.
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Affiliation(s)
- Guofu Zheng
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Hailiang Xie
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Minggui Lai
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Bao Qin
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Xiaochun Liu
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
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Bissacco D, Pisani C. The Other Side of Chronic Venous Disorder: Gaining Insights from Patients' Questions and Perspectives. J Clin Med 2024; 13:2539. [PMID: 38731068 PMCID: PMC11084709 DOI: 10.3390/jcm13092539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Venous disorders encompass a diverse range of manifestations and diseases, impacting a significant portion of the population. While life-threatening conditions are uncommon in non-thrombotic disorders, like telangiectasias or uncomplicated varicose veins (VVs), these conditions still have a substantial impact on affected individuals. Ensuring that patients are well informed about their venous disorder is a crucial step in their treatment journey. Providing them with valuable information regarding the disease's natural progression and available therapeutic options plays a pivotal role in optimizing their care. When patients are diagnosed with venous disorders, they often have numerous questions and concerns they want to discuss with their healthcare providers. Addressing these inquiries not only improves patients' knowledge and understanding but also influences their treatment compliance and overall outcomes. Therefore, it is of utmost importance to provide comprehensive explanations that address any doubts, uncertainties, and areas of confusion that patients may have. This report aims to present a concise, practical, and informative guide to venous disorders, focusing specifically on the common questions frequently raised by patients in everyday clinical practice. By serving as a valuable resource for healthcare professionals working in the field of venous diseases, this guide equips them with the necessary tools to effectively address patients' concerns and provide optimal care. By bridging the gap between patients' inquiries and medical expertise, this guide strives to enhance therapeutic outcomes and improve the overall management of venous disorders, ultimately empowering patients in their treatment journey.
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Affiliation(s)
- Daniele Bissacco
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Ghanaati H, Jalali AH, Shakiba M, Zarei D, Ghavami N, Firouznia K. Long-Term Clinical and Imaging Findings in Patients with Lower Extremity Varicose Veins Treated with Endovenous Laser Treatment: A Follow-Up Study of up to 12 Years. Int J Vasc Med 2024; 2024:6829868. [PMID: 38356738 PMCID: PMC10864052 DOI: 10.1155/2024/6829868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/19/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction This study investigates the long-term effectiveness and safety of endovenous laser treatment (EVLT) for chronic venous insufficiency (CVI), a condition commonly caused by dysfunctional valves in the venous circulation system. Materials and Methods In this retrospective cohort study, patients underwent EVLT and were followed up for successive short intervals and one last time after a median duration of 9-year postprocedural. Pre- and postprocedure duplex ultrasound was used to assess changes in the great saphenous vein (GSV) diameter, reflux, and saphenofemoral junction incompetence. Quality of life was evaluated using the SF-36 and Aberdeen Varicose Vein Questionnaire (AVVQ). Results Sixty-eight patients with a mean age of 52.4 ± 12.4 years were enrolled in the study. The mean follow-up time was 8.9 ± 2.1 years, ranging from 5 to 12 years. The mean GSV diameter significantly decreased in all patients (whole group) across proximal (from 5.8 ± 2.3 mm to 4.2 ± 2.1 mm), middle (from 4.7 ± 1.6 mm to 2.8 ± 2.2 mm), and distal (from 4.5 ± 2.3 mm to 2.2 ± 2.2 mm) segments, with P < 0.001. A disease recurrence rate of 33.8% was noted, predominantly in male patients and those with larger middle GSV diameters (OR = 5.2 (95%CI = 1.3-20.4) and OR = 1.5 (95%CI = 1-2.1), respectively). The average follow-up time for patients without recurrence was 8.8 ± 2.1 years. Almost half of the patients without recurrence were followed up for 10 years or more (49%). Conclusion The efficacy of EVLT in managing varicose veins is demonstrated by its relatively low recurrence rate over a 10-year follow-up period, highlighting EVLT as a viable long-term treatment strategy.
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Affiliation(s)
- Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Diana Zarei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Nafiseh Ghavami
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
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6
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Zhao N, Guo H, Zhang Y, Hu X, He JN, Wang D, Huang W, Gan H, Pang PF. Comparison of endovenous microwave ablation versus radiofrequency ablation for lower limb varicose veins. J Vasc Surg Venous Lymphat Disord 2024; 12:101662. [PMID: 37572775 DOI: 10.1016/j.jvsv.2023.03.022] [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] [Received: 11/30/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Endovenous microwave ablation (EMA) is a recently developed thermal ablation technique used in the treatment of lower limb varicose veins. However, its efficacy and safety have been largely understudied. In the present study, we sought to explore the clinical results of EMA and radiofrequency ablation (RFA) in treating lower limb varicose veins. METHODS Patients who underwent EMA (n = 65) or RFA (n = 46) at our institute from September 2018 to September 2020 were included in this retrospective investigation. The clinical results and complications were evaluated at 1, 3, 6, and 12 months after the procedure. The effects on disease severity and quality of life were evaluated using the venous clinical severity score and chronic venous insufficiency questionnaire (CIVIQ). RESULTS The technical success rate was 100% for both experimental groups. Although the operative time between the two groups was comparable, the EMA technique was associated with lower direct costs (P < .001), although also with prolonged hospitalization (P < .001). We found that the use of EMA correlated with more pain at 48 hours postoperatively. Except for the visual analog scale scores, no statistically significant variations were observed in the occurrence of postoperative complications within the first 48 hours postoperatively between the EMA and RFA groups, including paresthesia, ecchymosis, induration, and phlebitis (P > .05). At 4 weeks postoperatively, significantly less pigmentation was observed in the RFA group than in the EMA group (13.04% vs 32.31%; P = .020). However, the pigmentation had resolved in all patients by 12 months postoperatively. The two groups had a reduction in the venous clinical severity scores and an increase in the CIVIQ scores after the procedure. However, the CIVIQ scores within the RFA group had increased more than had those within the EMA group (P < .05). No significant differences were found in recurrence between the two groups (EMA group, 1.54%; RFA group, 2.17%; P = .804). CONCLUSIONS Both ablation techniques are safe and effective. RFA is associated with relatively higher treatment costs but shorter hospitalization and better quality of life improvement.
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Affiliation(s)
- Ni Zhao
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Hui Guo
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Yongyu Zhang
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Xiaojun Hu
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Jia-Nan He
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Dashuai Wang
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Weile Huang
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Hairun Gan
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Peng-Fei Pang
- Center for Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People's Republic of China.
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Dewi DAR, Arimuko A, Norawati L, Dewi RK, Wiraguna AAGP, Allatib A, Arkania N, Nadhira F, Wiliantari NM. Effectiveness of Sclerotherapy to Cure Lower Limb Chronic Venous Insufficiency Grades 1-6: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e49770. [PMID: 38164304 PMCID: PMC10758268 DOI: 10.7759/cureus.49770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Chronic venous insufficiency is a medical condition that impacts the venous system in the lower limbs. The primary characteristic of this condition is the continual elevation of pressure within the leg veins due to walking, which leads to a range of associated issues, such as discomfort, swelling, alterations in the skin, and the development of ulcers. Sclerotherapy has emerged as a potentially effective treatment for chronic venous insufficiency, involving the injection of a sclerosing agent into the affected veins. This study aimed to evaluate the effectiveness of sclerotherapy in treating chronic venous insufficiency grades 1-6 in the lower limb through a systematic review and meta-analysis. The method for conducting this research is by searching articles with relevant keywords carried out through electronic databases, such as Cochrane Library, Pubmed, and Google Scholar. The researchers conducted a comprehensive search and included randomized controlled trials and clinical trials that assessed outcomes, such as patient satisfaction, clinical resolution, quality of life (QoL), and closure rates. Statistical methods were used to analyze the data. The results of the meta-analysis from 9.670 total samples showed that sclerotherapy is the most effective therapy for reducing clinical severity in lower limb venous insufficiency patients (pooled MD = -0.85, 95% CI (-1.41, -0.29), p < 0.00001, I2 = 99%). Sclerotherapy is the most effective therapy for increasing QoL if we use Venous Insufficiency Epidemiology and Economic Study-Quality of Life (VEINES-QOL) as a tool for measuring the QoL (VEINES-QOL scale types; pooled MD = 10.34, 95% CI (8.78, 11.90), p < 0.00001, I2 = 0%). Additionally, sclerotherapy is a more effective therapy for increasing QoL compared to placebo (pooled MD = -1.64, 95% CI (-2.60, -0.67), p = 0.002, I2 = 90%), deferred ablation (pooled MD = -0.22, 95% CI (-0.40, -0.03), p = 0.02), and ligation therapy (pooled MD = -1.29, 95% CI (-1.62, -0.97), p = 0.00001). It is also the most effective therapy for increasing the closure rate for 12-month duration outcome measures (pooled RR = 0.72, 95% CI (0.55, 0.94), p = 0.001, I2 = 91%). However, high heterogeneity was observed in the meta-analysis results, indicating the need for further research to address this variability. This study contributes to the existing body of knowledge on the treatment options for chronic venous insufficiency and highlights the potential of sclerotherapy as an effective treatment modality.
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Affiliation(s)
- Dian Andriani Ratna Dewi
- Department of Dermatovenereology, Indonesian Defense University, Bogor, IDN
- Department of Dermatovenereology, Gatot Soebroto Army Central Hospital, Central Jakarta, IDN
| | - Abraham Arimuko
- Department of Dermatovenereology, Gatot Soebroto Army Central Hospital, Central Jakarta, IDN
| | - Lilik Norawati
- Department of Dermatovenereology, Gatot Soebroto Army Central Hospital, Central Jakarta, IDN
| | - Ratna K Dewi
- Department of Dermatovenereology, RKD's Principal Clinic, East Jakarta, IDN
| | | | - Arohid Allatib
- Department of Dermatovenereology, Faculty of Military Medicine, Indonesian Defense University, Bogor, IDN
| | - Nabila Arkania
- Department of Dermatovenereology, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, IDN
| | - Farrasila Nadhira
- Department of Dermatovenereology, Ratna Dewi Principal Clinic, Bekasi, IDN
| | - Ni M Wiliantari
- Department of Dermatovenereology, Ratna Dewi Principal Clinic, Bekasi, IDN
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Yu S, Li R, Cheng J, He Y, Xiao Y, Zhang M, Yu W, Qi X, Chen Y. Is catheter-based foam sclerotherapy more effective than direct foam sclerotherapy when combined with high ligation for the treatment of primary great saphenous vein incompetence? Vascular 2023; 31:981-988. [PMID: 35466837 DOI: 10.1177/17085381221094884] [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: 11/15/2022]
Abstract
BACKGROUND To retrospectively analyze the short-term outcomes of catheter-based versus direct foam sclerotherapy when combined with high ligation (HL) for the treatment of great saphenous vein (GSV) incompetence. METHODS From July 2018 to October 2019, a total of 82 lower limbs of 70 patients with GSV incompetence received HL combined with catheter-based foam sclerotherapy (CFS group) or direct foam sclerotherapy (DFS group) for GSV proximal trunk. Among them, 40 limbs of 36 patients were treated with CFS, and 42 limbs of 34 patients were treated with DFS. The occlusion of GSV proximal trunk was evaluated with venous duplex ultrasound examinations; Venous Clinical Severity Scores (VCSS) was used to assess clinical improvement; Aberdeen Varicose Veins Questionnaire (AVVQ) was used to assess quality-of-life scores; and Complications was used for the safety evaluation. RESULTS At day 7 post-operatively, complete occlusion of proximal trunk of the GSV was achieved in 92.5% legs of the CFS group and 71.4% of the DFS group (p = 0.014). Additionally, anterograde flow was found in 7.5% legs of the CFS group and 26.2% of the DFS group (p = 0.025). No significant differences in the occurrence of complications were observed between the two groups. The median follow-up was 285.5 days in the DFS group and 318 days in the CFS group (p = 0.140). VCSS and AVVQ reduction were significant in both CFS group and DFS group (5.3 ± 2.5, 5.5 ± 2.4, p < 0.001 for VCSS; 15.9 ± 8.0, 16.3 ± 8.6, p < 0.001 for AVVQ), but no significant difference were observed between two groups (p = 0.655 for VCSS, p = 0.934 for AVVQ). CONCLUSIONS Although the occlusion of great saphenous vein proximal trunk were different, two modalities result in similar clinical and quality-of-life improvements. DFS is a feasible alternative to CFS when combined with HL.
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Affiliation(s)
- Shixiong Yu
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruihao Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junning Cheng
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxian He
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Xiao
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingyi Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wu Yu
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaotong Qi
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yikuan Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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9
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Bossart S, Boesch PF, Keo HH, Staub D, Uthoff H. Endovenous Thermal Ablation for Treatment of Symptomatic Saphenous Veins-Does the Body Weight Matter? J Clin Med 2023; 12:5438. [PMID: 37685505 PMCID: PMC10487981 DOI: 10.3390/jcm12175438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE This study aimed to examine whether body weight may affect the effectiveness and safety of endovenous thermal ablation (ETA) for the treatment of symptomatic varicose veins. METHODS This retrospective single-center cohort study analyzed the outcomes and patient demographic data with a focus on the body weight of all patients who had ETA of symptomatic varicose veins between September 2017 and October 2020. RESULTS A total of 1178 treated truncal veins from 636 patients were analyzed. The mean ± standard deviation body mass index (BMI) was 25.5 ± 4.9. In 2.3% of cases, the patients were underweight (BMI < 18.5), 31.0% were overweight (BMI > 25), and 16.6% were obese (BMI > 30). Complete truncal occlusion was observed 1 year post intervention in 97.6-100% and patients were satisfied or very satisfied in 96.2-100% across BMI groups. Pain was low but significantly higher in the patients with obesity 6 weeks post intervention (visual analog scale 0.84 ± 1.49) and a higher infection rate was observed in the patients with obesity (n = 4/132; 3.0%). No significant association was observed between BMI and bleeding or thromboembolic events. CONCLUSIONS Patients with obesity experienced prolonged pain and more infections after ETA, but ETA for varicose vein treatment remains effective and safe, independent of the patient's BMI.
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Affiliation(s)
- Simon Bossart
- Gefässpraxis am See—Lakeside Vascular Center Lucerne, 6003 Lucerne, Switzerland; (P.F.B.); (H.U.)
- Department of Dermatology, Bern University Hospital Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Patricia Fiona Boesch
- Gefässpraxis am See—Lakeside Vascular Center Lucerne, 6003 Lucerne, Switzerland; (P.F.B.); (H.U.)
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, 4001 Basel, Switzerland; (H.H.K.); (D.S.)
- Vascular Institute Central Switzerland, 5000 Aarau, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, 4001 Basel, Switzerland; (H.H.K.); (D.S.)
| | - Heiko Uthoff
- Gefässpraxis am See—Lakeside Vascular Center Lucerne, 6003 Lucerne, Switzerland; (P.F.B.); (H.U.)
- Department of Angiology, University Hospital, University of Basel, 4001 Basel, Switzerland; (H.H.K.); (D.S.)
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Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord 2023; 11:231-261.e6. [PMID: 36326210 DOI: 10.1016/j.jvsv.2022.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
The Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society collaborated to update the 2011 Society for Vascular Surgery/American Venous Forum clinical practice guidelines and provide new evidence-based recommendations on critical issues affecting the care of patients with varicose veins. Each recommendation is based on a recent, independent systematic review and meta-analysis of the diagnostic tests and treatments options for patients with lower extremity varicose veins. Part I of the guidelines includes evidence-based recommendations for the evaluation of patients with CEAP (Clinical Class, Etiology, Anatomy, Pathology) class 2 varicose vein using duplex ultrasound scanning and other diagnostic tests, open surgical treatment (ligation and stripping) vs endovenous ablation techniques, thermal vs nonthermal ablation of the superficial truncal veins, and management of incompetent perforating veins in CEAP class 2 disease. We have also made recommendations on the concomitant vs staged treatment of varicose tributaries using phlebectomy or liquid or foam sclerotherapy (with physician-compounded foam or commercially prepared polidocanol endovenous microfoam) for patients undergoing ablation of incompetent superficial truncal veins.
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Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
| | - Peter F Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Suman M Wasan
- Department of Medicine, University of North Carolina, Chapel Hill, and Rex Vascular Specialists, UNC Health, Raleigh, NC
| | | | - Jose Almeida
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ruth L Bush
- Central Texas Veterans Affairs Healthcare System and Texas A&M University College of Medicine, Temple, TX
| | | | - John Fish
- Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Stanford, CA
| | | | | | - Arjun Jayaraj
- RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Raghu Kolluri
- Heart and Vascular Service, OhioHealth Riverside Methodist Hospital, Columbus, OH
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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11
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Whiteley MS. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol 2022; 15:567-583. [PMID: 35418769 PMCID: PMC8995160 DOI: 10.2147/ccid.s294990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/27/2022] [Indexed: 12/01/2022]
Abstract
This article outlines the current best practice in the management of varicose veins. “Varicose veins” traditionally means bulging veins, usually seen on the legs, when standing. It is now a general term used to describe these bulging veins, and also underlying incompetent veins that reflux and cause the surface varicose veins. Importantly, “varicose veins” is often used for superficial venous reflux even in the absence of visible bulging veins. These can be simply called “hidden varicose veins”. Varicose veins usually deteriorate, progressing to discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis and venous bleeds. Patients with varicose veins and symptoms or signs have a significant advantage in having treatment over conservative treatment with compression stockings or venotropic drugs. Small varicose veins or telangiectasia without symptoms or signs can be treated for cosmetic reasons. However, most have underlying venous reflux from saphenous, perforator or local “feeding veins” and so investigation with venous duplex should be mandatory before treatment. Best practice for investigating leg varicose veins is venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography optimally not the doctor who performs the treatment. Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol. In men or women unable to have TVS, venography or cross-sectional imaging is needed. Best practice for treating truncal vein incompetence is endovenous thermal ablation. Increasing evidence suggests that significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach, and that incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation. Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation. Monitoring and reporting outcomes is essential for doctors and patients; hence, participation in a venous registry should probably be mandatory.
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12
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Kim MH, Choi C. Second-generation treatment of varicose veins: endovenous thermal ablation by laser or radiofrequency ablation. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.4.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Endovenous thermal ablation (EVTA) is the second-generation treatment of varicose veins in the lower extremities. It has overcome the shortcomings of the first-generation treatment of high ligation and stripping. Further, it is the basis for the development of the third-generation treatment with endovenous glue ablation. It is currently recommended as the first-line treatment for varicose veins accompanied by great saphenous vein incompetence.Current Concepts: EVTA involves obliterating the varicosed veins by applying thermal energy to blood or vein wall. It can be performed by laser or radiofrequency ablation methods, under local anesthesia. The treatment results are excellent and show lesser pain and faster recovery compared to the first-generation treatment. However, complications include endovenous heat-induced thrombosis, deep vein thrombosis, ecchymosis, and phlebitis.Discussion and Conclusion: To enhance the therapeutic effect and reduce the complications of EVTA, sufficient tumescent anesthesia, a controlled number of firing in radiofrequency ablation, and use of the novel highwavelength laser and a radial catheter tip in endovenous laser ablation are recommended. In addition, proficiency in other generations of varicose vein treatments could help in various situations.
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13
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Liu P, Peng JL, Zhang F, Wang ZB, Zhang M, Niu XP, Su HY, Han YR, Wang YY. Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7730960. [PMID: 35069794 PMCID: PMC8769814 DOI: 10.1155/2022/7730960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the clinical effects of modified above-knee and conventional surgery with the stripping of the great saphenous vein of varicose veins of the lower extremities. METHODS Clinical data of patients with a varicose vein of the lower extremity from May 2016 to May 2018 were collected. A retrospective study was conducted on the patients receiving modified above-knee and conventional surgery with the great saphenous vein stripping. The baseline characteristics and long-term follow-up data were compared between the groups. RESULTS There were no significant differences in baseline characteristics between the two groups (P > 0.05). The surgeries were successfully performed by the same group of surgeons under local anesthesia and neuraxial anesthesia. The hospital stay, operation time, intraoperative blood loss, total length, and number of incisions in the above-knee group were comparable to those in the conventional surgery group (P > 0.05). The incidence of saphenous nerve injury and subcutaneous hematoma in the above-knee group was lower than that in the conventional surgery group (P < 0.05). There were no significant differences in recurrent varicose vein incidences (P > 0.05). After surgery, the venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) scores of both groups were higher than those before operation (P < 0.05). There was no significant difference in VCSS score or CIVIQ-14 scores between the two groups postoperation (P > 0.05). At 24 months after surgery, the above-knee group (71.8%) and conventional surgery group (73.2%) resulted in changes of at least two CEAP-C clinical classes lower than baseline, respectively. CONCLUSION The modified above-knee technique can ensure clinical outcomes, reduce intraoperative blood loss and complication incidences, and shorten the operative time. This gives evidence that the modified above-knee technique is worthy of clinical application.
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Affiliation(s)
- Peng Liu
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Jun-lu Peng
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Feng Zhang
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Zi-bin Wang
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Miao Zhang
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Xu-peng Niu
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Hai-ying Su
- Department of General Surgery, Jing Zhong Medical Area of PLA General Hospital, Beijing 100036, China
| | - Ya-ru Han
- Department of Vascular Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
| | - Yuan-yuan Wang
- Department of Gastrointestinal Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China
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14
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Outcomes of fluoroscopy-guided percutaneous high ligation of the great saphenous vein combined with foam sclerotherapy for symptomatic great saphenous veins. J Vasc Interv Radiol 2021; 33:445-450. [PMID: 34958858 DOI: 10.1016/j.jvir.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/28/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the greater saphenous veins (GSV). MATERIALS AND METHODS This was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSV (133 limbs) which were treated with FPHL combined with FGFS between April 1, 2019 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was percutaneously ligated by a percutaneously positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods. RESULTS The technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%), and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events. CONCLUSIONS FPHL combined with FGFS to treat varicose veins in the GSV achieved an occlusion rate of 92% and improved the clinical symptoms within one year; this minimally invasive procedure was safe and effective.
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15
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Farah MH, Nayfeh T, Urtecho M, Hasan B, Amin M, Sen I, Wang Z, Prokop LJ, Lawrence PF, Gloviczki P, Murad MH. A systematic review supporting the Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society guidelines on the management of varicose veins. J Vasc Surg Venous Lymphat Disord 2021; 10:1155-1171. [PMID: 34450355 DOI: 10.1016/j.jvsv.2021.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Several diagnostic tests and treatment options for patients with lower extremity varicose veins have existed for decades. The purpose of this systematic review was to summarize the latest evidence to support the forthcoming updates of the clinical practice guidelines on the management of varicose veins for the Society for Vascular Surgery (SVS), the American Venous Forum (AVF) and the American Vein and Lymphatic Society. METHODS We searched multiple databases for studies that addressed four clinical questions identified by the AVF and the SVS guideline committee about evaluating and treating patients with varicose veins. Studies were selected and appraised by pairs of independent reviewers. A meta-analysis was conducted when feasible. RESULTS We included 73 original studies (45 were randomized controlled trials) and 1 systematic review from 12,915 candidate references. Moderate certainty of evidence supported the usefulness of duplex ultrasound (DUS) examination as the gold standard test for diagnosing saphenous vein incompetence in patients with varicose veins and chronic venous insufficiency (clinical, etiological, anatomic, pathophysiological classification [CEAP] class C2-C6). High ligation and stripping (HL/S) was associated with higher anatomic closure rates at 30 days and 5 years when compared with radiofrequency ablation and ultrasound-guided foam sclerotherapy (UGFS) (moderate certainty), while no significant difference was seen when compared with endovenous laser ablation (EVLA) at 5 years. UGFS was associated with an increased risk of recurrence compared with HL/S. EVLA was associated with lower anatomic closure rates at 30 days than cyanoacrylate closure (CAC) and higher rates at one and 5 years when compared with UGFS. Thermal interventions were associated with lower generic quality of life scores and an increased risk of adverse events when compared with CAC or n-butyl cyanoacrylate (low certainty). Thermal interventions were associated with a lower risk of recurrent incompetence when compared with UGFS and an increased risk of recurrent incompetence than CAC. The evidence for great saphenous vein ablation alone to manage perforator disease was inconclusive. CONCLUSIONS The current systematic review summarizes the evidence to develop and support forthcoming updated SVS/AVF/American Vein and Lymphatic Society clinical practice guideline recommendations. The evidence supports duplex scanning for evaluating patients with varicose veins and confirms that HL/S resulted in similar long-term saphenous vein closure rates as EVLA and in better rates than radiofrequency ablation and UGFS. Thermal interventions were associated with inferior generic quality of life scores than nonthermal interventions, but had a lower risk of recurrent incompetence than UGFS. The recommendations in the guidelines should consider this information as well as other factors such as patients' values and preferences, anatomic considerations of individual patients, and surgical expertise.
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Affiliation(s)
- Magdoleen H Farah
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Tarek Nayfeh
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Meritxell Urtecho
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Bashar Hasan
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Mustapha Amin
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | - Indrani Sen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Zhen Wang
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
| | | | - Peter F Lawrence
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Calif
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn.
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Cost-effectiveness Analysis of Current Varicose Veins Treatments. J Vasc Surg Venous Lymphat Disord 2021; 10:504-513.e7. [PMID: 34450353 DOI: 10.1016/j.jvsv.2021.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyze the effectiveness and cost-effectiveness of technologies for treatment of varicose veins over 5 years - conservative care (CONS), surgery (HL/S), ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE). METHODS A systematic review was updated and used to construct a Markov decision model. Outcomes were re-intervention on the truncal vein, re-treatment of residual varicosities and quality-adjusted life years (QALY) and costs over five years. RESULTS UGFS has a significantly greater re-intervention rate than other procedures, while there is no significant difference between the other procedures. The cost per QALY of EVLA versus UGFS in our base-case model is £16966 ($23700) per QALY, which is considered cost-effective in the UK. RFA, MOCA and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients. CONCLUSIONS EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, CONS and HL/S are not cost-effective at current prices in the UK National Health Service. MOCA and CAE appear promising but further evidence on effectiveness, re-interventions and health-related quality of life is needed, as well as how cost-effectiveness may vary across settings and reimbursement systems.
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Abstract
BACKGROUND Great saphenous vein (GSV) incompetence, causing varicose veins and venous insufficiency, makes up the majority of lower-limb superficial venous diseases. Treatment options for GSV incompetence include surgery (also known as high ligation and stripping), laser and radiofrequency ablation, and ultrasound-guided foam sclerotherapy. Newer treatments include cyanoacrylate glue, mechanochemical ablation, and endovenous steam ablation. These techniques avoid the need for a general anaesthetic, and may result in fewer complications and improved quality of life (QoL). These treatments should be compared to inform decisions on treatment for varicosities in the GSV. This is an update of a Cochrane Review first published in 2011. OBJECTIVES To assess the effects of endovenous laser ablation (EVLA), radiofrequency ablation (RFA), endovenous steam ablation (EVSA), ultrasound-guided foam sclerotherapy (UGFS), cyanoacrylate glue, mechanochemical ablation (MOCA) and high ligation and stripping (HL/S) for the treatment of varicosities of the great saphenous vein (GSV). SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and AMED databases, and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 2 November 2020. We undertook reference checking to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) treating participants for varicosities of the GSV using EVLA, RFA, EVSA, UGFS, cyanoacrylate glue, MOCA or HL/S. Key outcomes of interest are technical success, recurrence, complications and QoL. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, applied Cochrane's risk of bias tool, and extracted data. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) and assessed the certainty of evidence using GRADE. MAIN RESULTS We identified 11 new RCTs for this update. Therefore, we included 24 RCTs with 5135 participants. Duration of follow-up ranged from five weeks to eight years. Five comparisons included single trials. For comparisons with more than one trial, we could only pool data for 'technical success' and 'recurrence' due to heterogeneity in outcome definitions and time points reported. All trials had some risk of bias concerns. Here we report the clinically most relevant comparisons. EVLA versus RFA Technical success was comparable up to five years (OR 0.98, 95% CI 0.41 to 2.38; 5 studies, 780 participants; moderate-certainty evidence); over five years, there was no evidence of a difference (OR 0.85, 95% CI 0.30 to 2.41; 1 study, 291 participants; low-certainty evidence). One study reported recurrence, showing no clear difference at three years (OR 1.53, 95% CI 0.78 to 2.99; 291 participants; low-certainty evidence), but a benefit for RFA may be seen at five years (OR 2.77, 95% CI 1.52 to 5.06; 291 participants; low-certainty evidence). EVLA versus UGFS Technical success may be better in EVLA participants up to five years (OR 6.13, 95% CI 0.98 to 38.27; 3 studies, 588 participants; low-certainty evidence), and over five years (OR 6.47, 95% CI 2.60 to 16.10; 3 studies, 534 participants; low-certainty evidence). There was no clear difference in recurrence up to three years and at five years (OR 0.68, 95% CI 0.20 to 2.36; 2 studies, 443 participants; and OR 1.08, 95% CI 0.40 to 2.87; 2 studies, 418 participants; very low-certainty evidence, respectively). EVLA versus HL/S Technical success may be better in EVLA participants up to five years (OR 2.31, 95% CI 1.27 to 4.23; 6 studies, 1051 participants; low-certainty evidence). No clear difference in technical success was seen at five years and beyond (OR 0.93, 95% CI 0.57 to 1.50; 5 studies, 874 participants; low-certainty evidence). Recurrence was comparable within three years and at 5 years (OR 0.78, 95% CI 0.47 to 1.29; 7 studies, 1459 participants; and OR 1.09, 95% CI 0.68 to 1.76; 7 studies, 1267 participants; moderate-certainty evidence, respectively). RFA versus MOCA There was no clear difference in technical success (OR 1.76, 95% CI 0.06 to 54.15; 3 studies, 435 participants; low-certainty evidence), or recurrence (OR 1.00, 95% CI 0.21 to 4.81; 3 studies, 389 participants; low-certainty evidence). Long-term data are not available. RFA versus HL/S No clear difference in technical success was detected up to five years (OR 5.71, 95% CI 0.64 to 50.81; 2 studies, 318 participants; low-certainty evidence); over five years, there was no evidence of a difference (OR 0.88, 95% CI 0.29 to 2.69; 1 study, 289 participants; low-certainty evidence). No clear difference in recurrence was detected up to three years (OR 0.93, 95% CI 0.58 to 1.51; 4 studies, 546 participants; moderate-certainty evidence); but a possible long-term benefit for RFA was seen (OR 0.41, 95% CI 0.22 to 0.75; 1 study, 289 participants; low-certainty evidence). UGFS versus HL/S Meta-analysis showed a possible benefit for HL/S compared with UGFS in technical success up to five years (OR 0.32, 95% CI 0.11 to 0.94; 4 studies, 954 participants; low-certainty evidence), and over five years (OR 0.09, 95% CI 0.03 to 0.30; 3 studies, 525 participants; moderate-certainty evidence). No clear difference was detected in recurrence up to three years (OR 1.81, 95% CI 0.87 to 3.77; 3 studies, 822 participants; low-certainty evidence), and after five years (OR 1.24, 95% CI 0.57 to 2.71; 3 studies, 639 participants; low-certainty evidence). Complications were generally low for all interventions, but due to different definitions and time points, we were unable to draw conclusions (very-low certainty evidence). Similarly, most studies evaluated QoL but used different questionnaires at variable time points. Rates of QoL improvement were comparable between interventions at follow-up (moderate-certainty evidence). AUTHORS' CONCLUSIONS Our conclusions are limited due to the relatively small number of studies for each comparison and differences in outcome definitions and time points reported. Technical success was comparable between most modalities. EVLA may offer improved technical success compared to UGFS or HL/S. HL/S may have improved technical success compared to UGFS. No evidence of a difference was detected in recurrence, except for a possible long-term benefit for RFA compared to EVLA or HL/S. Studies which provide more evidence on the breadth of treatments are needed. Future trials should seek to standardise clinical terminology of outcome measures and the time points at which they are measured.
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Affiliation(s)
- Jade Whing
- Northern Vascular Centre, Freeman Hospital, Newcastle, UK
| | - Sandip Nandhra
- Northern Vascular Centre, Freeman Hospital, Newcastle, UK
| | - Craig Nesbitt
- Northern Vascular Centre, Freeman Hospital, Newcastle, UK
| | - Gerard Stansby
- Northern Vascular Centre, Freeman Hospital, Newcastle, UK
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Siribumrungwong B, Wilasrusmee C, Orrapin S, Srikuea K, Benyakorn T, McKay G, Attia J, Rerkasem K, Thakkinstian A. Interventions for great saphenous vein reflux: network meta-analysis of randomized clinical trials. Br J Surg 2021; 108:244-255. [PMID: 33793723 PMCID: PMC10364879 DOI: 10.1093/bjs/znaa101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/12/2020] [Accepted: 11/01/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent. METHODS A systematic review and network meta-analysis of RCTs was performed to compare rates of incomplete stripping or non-occlusion of the great saphenous vein with or without reflux (anatomical failure) at early, mid- and long-term follow-up; and secondary outcomes (reintervention and clinical recurrence) among intervention groups. The surface under the cumulative ranking curve (SUCRA) method was used to estimate the probability of the intervention with the lowest anatomical failure rates. RESULTS Some 72 RCTs were included. Comparisons of endothermal techniques with open surgery were mostly not significantly different, except for endovenous laser ablation (EVLA), which had higher long-term anatomical failure rates (pooled risk ratio (RR) 1.87, 95 per cent c.i. 1.14 to 3.07). Mechanochemical ablation had higher anatomical failure rates than radiofrequency ablation (RFA) (pooled RR 2.77, 1.38 to 5.53), and cyanoacrylate closure (CAC) had a RR 0.56 (0.34 to 0.93) times lower than either RFA or EVLA at the early term. Ultrasound-guided foam sclerotherapy had a higher risk of anatomical failure and reintervention than open surgery, with the lowest SUCRA value, and CAC was ranked first, third and first for best intervention for anatomical failure at early, mid and long term respectively. However, clinical recurrence rates were not significantly different between all comparisons. CONCLUSION Mechanochemical ablation and ultrasound-guided foam sclerotherapy performed poorly, with higher anatomical failure rates in the long term. The other treatment modalities had similar rates of anatomical failure in the short and mid term.
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Affiliation(s)
- B Siribumrungwong
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand.,Centre of Excellence in Applied Epidemiology, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
| | - C Wilasrusmee
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Orrapin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
| | - K Srikuea
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
| | - T Benyakorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani, Thailand
| | - G McKay
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - J Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, and Hunter Medical Research Institute, NSW, Australia
| | - K Rerkasem
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine; Non-Communicable Disease Centre of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - A Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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19
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Ulloa JH, Comerota A, Figueroa V, Cifuentes S. GREAT SAPHENOUS VEIN OCCLUSION RATES AFTER COMBINED TREATMENT WITH LASER AND FOAM SCLEROTHERAPY. J Vasc Surg Venous Lymphat Disord 2021; 9:1437-1442. [PMID: 34174499 DOI: 10.1016/j.jvsv.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endovenous Laser Ablation (EVLA) and foam sclerotherapy are effective and safe treatments for chronic venous disease (CVD) with great saphenous vein (GSV) reflux. We report our experience combining both strategies as a merged approach to treat GSV incompetence to potentiate both methods' superiority and benefits. We aimed to determine the effectiveness of this treatment strategy. METHODS 246 limbs with great saphenous vein incompetence (C2-C6) treated with EVLA and foam sclerotherapy between January 2016 and December 2019 were retrospectively analyzed. Outcomes of interest were the International Union of Phlebology type of anatomic closure (primary, primary assisted, secondary and therapeutic failure), identified with ultrasound in the GSV after the procedure. Clinical and ultrasound follow-up was conducted at two weeks, 3, 6, and 12 months post-intervention. We utilized Fisher's exact test to determine the significance of the association between the type of anatomic closure and the clinical stage according to the CEAP classification. RESULTS 67% of the treated limbs were C2-C4 and 33% C5-C6. International Union of Phlebology (IUP) primary closure was achieved in 229 limbs (93%), IUP primary assisted closure in 10 (4%), IUP secondary closure in 1 (0.4%), with therapeutic failure in 6 limbs (2%). Forty-five limbs (18%) required microthrombectomies of tributary veins due to local induration, 7 (2.8%) developed dyschromia, 4 (1.6%) had type 1 Endovenous Heat-Induced Thrombosis (E-HIT1), and one limb (0.4%) developed deep vein thrombosis (DVT), which was successfully treated with anticoagulation. CONCLUSIONS Our results demonstrate a high occlusion rate of incompetent GSVs with combined EVLA and foam sclerotherapy with infrequent non-serious complications and one case of subclinical isolated popliteal DVT. Combined therapy effectiveness and safety are comparable with other endovenous treatments for CVD with GSV reflux. The use of both thermal and chemical ablation combines the benefits of both techniques.
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Affiliation(s)
- Jorge H Ulloa
- Division of Vascular Surgery, Department of Surgery, Universidad de los Andes, Bogota, Colombia; Division of Vascular Surgery, Department of Surgery, Fundacion Santa Fe de Bogota, Bogota, Colombia.
| | | | - Valentin Figueroa
- Division of Vascular Surgery, Department of Surgery, Universidad de los Andes, Bogota, Colombia; Division of Vascular Surgery, Department of Surgery, Fundacion Santa Fe de Bogota, Bogota, Colombia
| | - Sebastian Cifuentes
- Division of Vascular Surgery, Department of Surgery, Universidad de los Andes, Bogota, Colombia; Division of Vascular Surgery, Department of Surgery, Fundacion Santa Fe de Bogota, Bogota, Colombia
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20
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Orhurhu V, Chu R, Xie K, Kamanyi GN, Salisu B, Salisu-Orhurhu M, Urits I, Kaye RJ, Hasoon J, Viswanath O, Kaye AJ, Karri J, Marshall Z, Kaye AD, Anahita D. Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review. Cardiol Ther 2021; 10:111-140. [PMID: 33704678 PMCID: PMC8126535 DOI: 10.1007/s40119-021-00213-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE OF REVIEW Chronic venous insufficiency is found to some extent in a large proportion of the world's population, especially in the elderly and obese. Despite its prevalence, little research has been pursued into this pathology when compared to similarly common conditions. Pain is often the presenting symptom of chronic venous insufficiency and has significant deleterious effects on quality of life. This manuscript will describe the development of pain in chronic venous insufficiency, and will also review both traditional methods of pain management and novel advances in both medical and surgical therapy for this disease. RECENT FINDINGS Pain in chronic venous insufficiency is a common complication which remains poorly correlated in recent studies with the clinically observable extent of disease. Although lifestyle modification remains the foundation of treatment for pain associated with chronic venous sufficiency, compression devices and various pharmacologic agents have emerged as safe and effective treatments for pain in these patients. In patients for whom these measures are insufficient, recently developed minimally invasive vascular surgical techniques have been shown to reduce postsurgical complications and recovery time, although additional research is necessary to characterize long-term outcomes of these procedures. This review discusses the latest findings concerning the pathophysiology of pain in chronic venous insufficiency, conservative and medical management, and surgical strategies for pain relief, including minimally invasive treatment strategies.
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Affiliation(s)
- Vwaire Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Robert Chu
- Johns Hopkins School of Medicine, Baltimore, MA, USA
| | | | | | | | - Mariam Salisu-Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC, USA
| | - Jamal Hasoon
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport Shreveport, Shreveport, LA, USA
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Aaron J Kaye
- Medical University of South Carolina, Charleston, SC, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Zwade Marshall
- Regenerative Spine and Pain Specialist, Fayetteville, GA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport Shreveport, Shreveport, LA, USA
| | - Dua Anahita
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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21
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Lomazzi C, Bissacco D, Logan MS, Grassi V, Piffaretti G, Trimarchi S, L Bush R. Risk factors for saphenous vein recanalization after endovenous radiofrequency ablation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:427-434. [PMID: 34014061 DOI: 10.23736/s0021-9509.21.11908-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Target vein recanalization is defined as the postoperative detection of blood flow in a venous segment previously ablated. It can be occurred after thermal-tumescent procedures, as radiofrequency (RFA) and endovenous laser (EVLA) ablation techniques. Despite several papers described and analyzed incidence and consequences of recanalization, limited data are published on risk factors for this condition. The aim of this general review is to investigate clinical and instrumental risk factors for great and small saphenous veins recanalization after RFA, indicating their impact in the follow-up period.
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Affiliation(s)
- Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Viviana Grassi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Piffaretti
- Vascular Surgery Unit, ASST Settelaghi University Teaching Hospital, Varese, Italy.,Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, TX, USA
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22
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Outcomes of Saphenous Vein Intervention in the Management of Superficial Venous Incompetence: A Systematic Review and Network Meta-Analysis. Ann Surg 2021; 275:e324-e333. [PMID: 33843795 DOI: 10.1097/sla.0000000000004914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the most effective modality of intervention to treat saphenous vein insufficiency. SUMMARY BACKGROUND DATA Endovenous therapies have instigated a paradigm shift in the management of superficial venous incompetence (SVI). When compared with open surgery, endovenous interventions (foam sclerotherapy (FS), radiofrequency ablation (RFA), endovenous laser ablation (EVLA), mechanochemical ablation (MOCA), and cyanoacrylate glue (CAE) closure) potentially offer reduced morbidity with similar procedural efficacy. METHODS A systematic review and series of network meta-analyses of randomized controlled trials (RCTs) were performed assessing risks of procedural failure (within 6-weeks) and recurrence (6-weeks to 5-years), defined by ultrasound, between the different SVI modalities. Treatment comparisons addressing risks of common adverse events, Venous Clinical Severity Score (VCSS) and pain were also performed. RESULTS A systematic search identified 51 articles, describing 36 RCTs, incorporating 7,576 limbs. Outcome data on ten modalities of intervention were analyzed up to five-year follow-up. CAE resulted in the lowest risk of procedural failure within six-weeks. Foam sclerotherapy had the highest risk of recurrence while high ligation with stripping (HLS) and CHIVA were ranked best to reduce long-term recurrence. No intervention increased risks of venous thromboembolism and there was minimal difference in morbidity between treatments. All interventions improved VCSS (Range -1.02 to -4.95), however RFA demonstrated the greatest improvement, followed by EVLA and HLS between two to five-years. EVLA was associated with the highest risk of pain, while MOCA offered the least. CONCLUSION While CAE offered the lowest risk of initial procedural failure, HLS resulted in lower rates of long-term recurrence without considerably increasing morbidity when compared with other endovenous options.
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23
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Erben Y, Vasquez I, Li Y, Gloviczki P, Kalra M, Oderich G, De Martino RR, Bjarnason H, Neisen MJ, Moore JF, Da Rocha-Franco JA, Sanchez-Valenzuela MC, Frey G, Toskich B, Devcic Z, Farres H, Oldenburg WA, Gomez-Perez J, Yarbrough JR, Adalia M, Stone W, Meltzer AJ, Hakaim AG. A multi-institutional review of endovenous thermal ablation of the saphenous vein finds male sex and use of anticoagulation are predictors of long-term failure. Phlebology 2020; 36:283-289. [PMID: 33176592 DOI: 10.1177/0268355520972923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To review long-term outcomes and saphenous vein (SV) occlusion rate after endovenous ablation (EVA) for symptomatic varicose veins. METHODS A review of our EVA database (1998-2018) with at least 3-years of clinical and sonographic follow-up. The primary end point was SV closure rate. RESULTS 542 limbs were evaluated. 358 limbs had radiofrequency and 323 limbs had laser ablations; 542 great saphenous veins (GSV), 106 small saphenous veins (SSV) and 33 anterior accessory saphenous veins (AASV) were treated. Follow-up was 5.6 ± 2.3 years; 508 (74.6%) veins were occluded, 53 (7.8%) partially occluded and 120 (17.6%) were patent. On multivariable Cox regression analysis, male sex (HR 1.6, 95% CI [0.46-018], p = 0.012) and use anticoagulation (HR 2.0, 95% CI [0.69-0.34], p = 0.044) were predictors of long-term failure. On Kaplan-Meier curve, we had an 86.3% occlusion rate. CONCLUSION Our experience revealed a 5-year closure rate of 86.3%. Ablations have satisfactory occlusion rate.
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Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Isabel Vasquez
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ, USA
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Haraldur Bjarnason
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Melissa J Neisen
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - January F Moore
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Gregory Frey
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Beau Toskich
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Zlatko Devcic
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Warren A Oldenburg
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jessica Gomez-Perez
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Justin R Yarbrough
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Michael Adalia
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - William Stone
- Divsion of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Andrew J Meltzer
- Divsion of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Albert G Hakaim
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
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24
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Vähäaho S, Halmesmäki K, Mahmoud O, Albäck A, Noronen K, Venermo M. Three-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins. J Vasc Surg Venous Lymphat Disord 2020; 9:652-659. [PMID: 32795619 DOI: 10.1016/j.jvsv.2020.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mechanochemical ablation (MOCA) is a nonthermal nontumescent method of treating saphenous vein insufficiency. The feasibility and short-term results of MOCA are good, but its long-term results are unknown. A randomized study was performed to compare MOCA with endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in the setting of unilateral great saphenous vein (GSV) insufficiency. METHODS Venous outpatient clinic patients with varicose veins (CEAP class C2-C4) caused by GSV insufficiency were invited to participate in the study; in total, 132 patients met the inclusion criteria and were willing to participate. Patients were randomized to treatment (2:1:1 for MOCA, EVLA, and RFA, respectively). The state of the GSV with duplex Doppler ultrasound examination and the disease-specific quality of life were assessed at 1 month, 1 year, and 3 years after the treatment. RESULTS Some patients declined to continue in the study after randomization; in total, 117 patients underwent treatment. At 3 years, the occlusion rate was significantly lower with MOCA than with either EVLA or RFA (82% vs 100%; P = .005). Quality of life was similar between the groups. In the MOCA group, GSVs that were larger than 7 mm in diameter preoperatively were more likely to recanalize during the follow-up period. The partial recanalizations of proximal GSV observed at 1 year progressed during the follow-up. CONCLUSIONS MOCA is a feasible treatment option in an outpatient setting, but its technical success rates are inferior compared with endovenous thermal ablation. Its use in large-caliber veins should be considered carefully.
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Affiliation(s)
- Sari Vähäaho
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
| | - Karolina Halmesmäki
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Osman Mahmoud
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Anders Albäck
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Katarina Noronen
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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25
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Karam B, Moussally M, Nassar H, Ataya K, Jaafar R, Haddad F. Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up. Phlebology 2020; 36:43-47. [PMID: 32660372 DOI: 10.1177/0268355520939744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. METHODS This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. RESULTS Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. CONCLUSION EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.
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Affiliation(s)
- Boutros Karam
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Moussally
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Nassar
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Karim Ataya
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Jaafar
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady Haddad
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
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26
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Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B, Giannoukas A, Lugli M, Maleti O, Mansilha A, Myers KA, Nelzén O, Partsch H, Perrin M. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part II. INT ANGIOL 2020; 39:175-240. [PMID: 32214074 DOI: 10.23736/s0392-9590.20.04388-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | | | | | - Bo Eklof
- American Venous Forum, Hoffman Eastates, IL, USA
| | | | | | | | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Department of Angiology and Vascular Surgery, S. João Hospital, Porto, Portugal
| | | | - Olle Nelzén
- Vascular Surgery Unit, Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden
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27
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Morrison N, Gibson K, Vasquez M, Weiss R, Jones A. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord 2020; 8:978-989. [PMID: 32205125 DOI: 10.1016/j.jvsv.2019.12.080] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The proprietary cyanoacrylate closure (CAC) system vs radiofrequency ablation (RFA) trial (VenaSeal Sapheon Closure System Pivotal Study [VeClose]) showed that CAC, a nontumescent, nonthermal, nonsclerosant ablation technique, was effective and noninferior to RFA in vein closure with good 36-month outcomes. Conducted under a separate protocol, the aim of this extended follow-up was to assess the long-term safety and effectiveness of CAC and RFA for the treatment of incompetent great saphenous veins (GSV) at 5 years (60 months) of follow-up. METHODS This 60-month extension study was conducted for all patients who completed the randomized VeClose study and who were willing to participate. The pivotal VeClose study included patients with symptomatic moderate to severe varicosities (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] class C2-C4b) and symptomatic GSV incompetence who were randomly assigned (1:1) to either CAC or RFA. The primary outcome measure of this 60-month extension study was complete closure of the target vein, with planned exploratory analysis of noninferiority. Secondary outcomes included CEAP class; completion of the Venous Clinical Severity Score, EuroQol-Five Dimension survey, and Aberdeen Varicose Vein Questionnaire; patient satisfaction with treatment; adverse events (AEs) related to target GSV; and details of adjunctive procedures. RESULTS A total of 89 patients completed the 60-month visit, which included 47 from the CAC group, 33 from the RFA group, and 9 CAC roll-in patients. No new recanalization events have been observed in the groups between 36 and 60 months of follow-up. At 60 months, Kaplan-Meier estimates for freedom from recanalization in the randomized CAC and RFA groups were 91.4% and 85.2%, respectively, demonstrating noninferiority of CAC compared with RFA. Both groups demonstrated sustained improvements in EuroQol-Five Dimension and quality of life measures through 60 months. Whereas patients assigned to C0 or C1 clinical class were excluded from the original study, more than half of all returning patients (64% [57/89]) were now assigned to C0 or C1, suggesting an improved clinical class from baseline. Furthermore, 41.1% of returning CAC patients and 39.4% of returning RFA patients are presently at least two CEAP clinical classes lower than at baseline. No long-term device- or procedure-related serious AEs occurred in either group between 36- and 60-month follow-up. CONCLUSIONS CAC and RFA were effective in achieving complete target vein closure of the GSV at long-term follow-up, with CAC demonstrating continued noninferiority to RFA. CAC was also associated with sustained improvements in symptoms and quality of life, lower CEAP class, and high level of patient satisfaction without serious AEs between 36 and 60 months.
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28
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Liu X, Zheng G, Ye B, Chen W, Xie H, Zhang T, Lin J. A retrospective cohort study comparing two treatments for active venous leg ulcers. Medicine (Baltimore) 2020; 99:e19317. [PMID: 32080149 PMCID: PMC7034671 DOI: 10.1097/md.0000000000019317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced traditional surgery for treatment of varicose veins (VVs) with active venous leg ulcers (VLUs), and multiple combined modes have emerged. A retrospective cohort study was performed to compare the effect of traditional surgery (high ligation and stripping followed with compression [compression plus HL-S]) to high ligation-endovenous laser ablation-foam sclerotherapy followed with compression (compression plus HL-EVLA-FS) on the treatment of active VLUs.Data of active VLUs treated in our center from 2008 to 2017 and followed up for 1 year were analyzed. The intervention measures in the first 5 years were compression plus HL-S, and in the following 5 years were compression plus HL-EVLA-FS. The primary outcome was ulcer healing time. The secondary outcomes were the VVs occlusion and clinical success as assessed by a change in venous clinical severity score (VCSS) and complications.The study included 120 patients and 200 patients treated with HL-S and HL-EVLA-FS, respectively, during 2008 to 2017. The average ulcer healing time were 2.3 ± 2.4 and 1.7 ± 1.7 months, respectively. Significant difference was found in the cumulative ulcers healing rate between the two groups (Hazard ratio [HR] and 95% confidence interval [CI] was respectively 1.458 and 1.140-1.865, P = .0002), but no difference was found in the VVs occlusion (HR and 95% CI was respectively 1.005 and 0.774-1.3071, P = .967). Significant difference occurred in 6 months and 12 months post-operatively in the VCSS change and in the procedure data and some complications between the 2 groups.In conclusion, the treatment of HL-EVLA-FS can accelerate the healing of VLUs, improve the VCSS and present superior procedure data. However, no advantage could be found in the VVs occlusion compared with control group.
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29
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Lim SY, Tan JX, D'Cruz RT, Syn N, Chong TT, Tang TY. Catheter-directed foam sclerotherapy, an alternative to ultrasound-guided foam sclerotherapy for varicose vein treatment: A systematic review and meta-analysis. Phlebology 2020; 35:369-383. [PMID: 31918640 DOI: 10.1177/0268355519898309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Catheter-directed foam sclerotherapy is a new addition to the treatment modalities available for varicose veins. As a modification of ultrasound-guided foam sclerotherapy, catheter-directed foam sclerotherapy has been purported to offer higher complete ablation rates and an improved safety profile. The aim of this study is to appraise the current literature on the outcomes of catheter-directed foam sclerotherapy compared to ultrasound-guided foam sclerotherapy in chronic venous insufficiency. METHODS The review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data from studies that reported the outcomes of catheter-directed foam sclerotherapy and ultrasound-guided foam sclerotherapy were extracted, to determine the pooled proportion of complete ablation rates, using a random effect meta-analysis model. RESULTS A total of 62 studies, involving 3689 patients, were included in the systematic review. Higher rates of complete ablation were reported in catheter-directed foam sclerotherapy compared to ultrasound-guided foam sclerotherapy during the short- and medium-term follow-ups (Relative Risk = 1.06, Relative Risk = 1.15, Relative Risk = 1.19, p < 0.05). Fewer major and minor complications were also reported in patients who underwent catheter-directed foam sclerotherapy (Relative Risk = 0.23, Relative Risk= 0.43-0.76, p < 0.05). CONCLUSION Catheter-directed foam sclerotherapy has been demonstrated to have many advantages over ultrasound-guided foam sclerotherapy, offering superior complete ablation rates in the short-, medium- and long-term follow-ups. It also has a better safety profile, conferring a lower risk of major and minor complications. The conclusions should however be viewed in the context of significant limitations imposed by limited study data.
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Affiliation(s)
- Sheng Y Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua Xd Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Reuban T D'Cruz
- Department of General Surgery, National University Hospital, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tze T Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tjun Y Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
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30
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Rai A, Porsalman M, Khatony A, Sobhiyeh M. Comparison of foam sclerotherapy versus radiofrequency ablation in the treatment of primary varicose veins due to incompetent great saphenous vein: Randomized clinical trial. JOURNAL OF VASCULAR NURSING 2019; 37:226-231. [PMID: 31847976 DOI: 10.1016/j.jvn.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Minimally invasive procedures such as foam sclerotherapy and radiofrequency ablation (RFA) have gained attention for treatment of incompetent great saphenous vein (GSV). The objective of this study was to compare recurrence rate and quality of life between foam sclerotherapy and RFA in patients with incompetent GSV varicose veins. METHODS In this parallel single-blinded randomized clinical trial, 60 adult patients with primary varicose veins due to incompetent GSV (CEAP classes C2-4EPAsPr) were included and randomly divided to receive RFA or foam sclerotherapy. Health-related quality of life (HRQOL) was assessed by the Short Form 36, and the Aberdeen Varicose Vein Questionnaire (AVVQ) was applied to assess the impact of varicose veins on quality of life of the patients. In addition, pain severity after the procedures was investigated by a visual analog scale (VAS) (range, 0 to 10). The patients were followed at 1 week, 1 month, 3 months, and 6 months postoperation. GSV reflux and recurrence was assessed by color Doppler ultrasound examination after 6 months. RESULTS Twenty-eight patients in RFA and 27 patients in foam sclerotherapy remained for the final analyses. The time interval from the procedure and recovery to daily normal activities was 1 day in both groups. Mean (±SD) pain VAS score in RFA group decreased from preintervention score of 7.35 (±3.28) to 1.21 (±0.68); P < .0001. Likewise, this score decreased from 6.64 (±2.04) to 1.29 (±0.91) in foam sclerotherapy group. HRQOL scores increased gradually at 1, 3, and 6 months after the intervention. AVVQ scores decreased significantly 1 week postintervention in both groups. After 6 months, 17.9% (5 patients) in RFA group and 14.8% (4 patients) in foam sclerotherapy group had recurrence of GSV reflux (P = .52). CONCLUSION Both foam sclerotherapy and RFA were effective in treatment of GSV reflux. Comparable findings were observed between the 2 groups regarding postoperative pain, recovery time, HRQOL, and AVVQ scores.
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Affiliation(s)
- Alireza Rai
- Department of Cardiology, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahtab Porsalman
- Department of Surgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Department of Community Health, Medical Surgical Nursing, School of Nursing and Midwifery, Infectious Diseases Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadreza Sobhiyeh
- Department of Vascular and Endovascular Surgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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31
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Critello CD, Pullano SA, Matula TJ, De Franciscis S, Serra R, Fiorillo AS. Recent developments on foaming mechanical and electronic techniques for the management of varicose veins. Expert Rev Med Devices 2019; 16:931-940. [PMID: 31622557 DOI: 10.1080/17434440.2019.1682549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Varicose veins are a common disease, causing significant impairment of quality of life to afflicted individuals. Conventional surgery has represented the traditional treatment for years, with significant post-operative complications. By the end of the 20th century, novel approaches had been developed to induce biochemical sclerosis into the treated vein in order to exclude it from blood circulation.Areas covered: Foaming techniques for treatment of varicose veins, both clinically-approved methods and those under experimental studies. A brief description of cavitation, which is the basis of microbubbles formation, and an overview of foam properties have been also provided, including a discussion on clinical efficacy and safety profile.Expert commentary: Foam sclerotherapy has rapidly gained popularity since it represents the most minimally invasive and cost-effective procedure in the short term. Several different methods of foam preparation have been described in literature. In general, the foam generation method may affect characteristics such as stability and bubble size distribution, which in turn affect the therapeutic action of foam itself. Therefore, the selection of a suitable foaming technique is of importance for treatment success. Future developments on foaming techniques are expected to make sclerotherapy, already an effective treatment, even safer and more versatile therapeutic procedure.
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Affiliation(s)
- C Davide Critello
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Salvatore A Pullano
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Thomas J Matula
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Stefano De Franciscis
- Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Department of Surgical and Medical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonino S Fiorillo
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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32
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Gianesini S, Obi A, Onida S, Baccellieri D, Bissacco D, Borsuk D, Campisi C, Campisi CC, Cavezzi A, Chi YW, Chunga J, Corda D, Crippa A, Davies A, De Maeseneer M, Diaz J, Ferreira J, Gasparis A, Intriago E, Jawien A, Jindal R, Kabnick L, Latorre A, Lee BB, Liew NC, Lurie F, Meissner M, Menegatti E, Molteni M, Morrison N, Mosti G, Narayanan S, Pannier F, Parsi K, Partsch H, Rabe E, Raffetto J, Raymond-Martimbeau P, Rockson S, Rosukhovski D, Santiago FR, Schul A, Schul M, Shaydakov E, Sibilla MG, Tessari L, Tomaselli F, Urbanek T, van Rijn MJ, Wakefield T, Wittens C, Zamboni P, Bottini O. Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts' opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019. Phlebology 2019; 34:4-66. [PMID: 31495256 DOI: 10.1177/0268355519870690] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.
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Affiliation(s)
| | - Andrea Obi
- 2 University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Denis Borsuk
- 6 Clinic of Phlebology and Laser Surgery, 'Vasculab' Ltd, Chelyabinsk, Russia
| | | | | | - Attilio Cavezzi
- 9 Eurocenter Venalinfa, San Benedetto del Tronto (AP), Italy
| | - Yung-Wei Chi
- 10 University of California, Davis Vascular Center, Sacramento, CA, USA
| | | | | | | | | | | | - Josè Diaz
- 15 Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julio Ferreira
- 16 Instituto Brasilerio de Flebologia, Sao Paulo, Brazil
| | | | | | - Arkadiusz Jawien
- 19 Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland
| | | | | | | | | | - N C Liew
- 24 Putra University, Serdang, Malaysia
| | - Fedor Lurie
- 25 Jobst Vascular Institute, Toledo, OH, USA
| | | | | | | | | | | | | | | | - Kurosh Parsi
- 32 St. Vincent's Hospital, University of NSW, Sydney, Australia
| | | | | | | | | | - Stanley Rockson
- 37 Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Cees Wittens
- 44 Maastricht University Medical Center, Maastricht, Netherlands.,45 Uniklinik Aachen, Aachen, Germany
| | | | - Oscar Bottini
- 46 Universidad de Buenos Aires, Buenos Aires, Argentina
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Brittenden J, Cooper D, Dimitrova M, Scotland G, Cotton SC, Elders A, MacLennan G, Ramsay CR, Norrie J, Burr JM, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, Tassie E, Francis J, Campbell MK. Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins. N Engl J Med 2019; 381:912-922. [PMID: 31483962 DOI: 10.1056/nejmoa1805186] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endovenous laser ablation and ultrasound-guided foam sclerotherapy are recommended alternatives to surgery for the treatment of primary varicose veins, but their long-term comparative effectiveness remains uncertain. METHODS In a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of laser ablation, foam sclerotherapy, and surgery. Primary outcomes at 5 years were disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants' treatment costs and scores on the EuroQol EQ-5D questionnaire. RESULTS Quality-of-life questionnaires were completed by 595 (75%) of the 798 trial participants. After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, -2.86; 95% confidence interval [CI], -4.49 to -1.22; P<0.001; and for surgery vs. foam sclerotherapy, -2.60; 95% CI, -3.99 to -1.22; P<0.001). Generic quality-of-life measures did not differ among treatment groups. At a threshold willingness-to-pay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation. In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery. CONCLUSIONS In a randomized trial of treatments for varicose veins, disease-specific quality of life 5 years after treatment was better after laser ablation or surgery than after foam sclerotherapy. The majority of the probabilistic cost-effectiveness model iterations favored laser ablation at a willingness-to-pay ratio of £20,000 ($28,433) per QALY. (Funded by the National Institute for Health Research; CLASS Current Controlled Trials number, ISRCTN51995477.).
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Affiliation(s)
- Julie Brittenden
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - David Cooper
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Maria Dimitrova
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Graham Scotland
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Seonaidh C Cotton
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Andrew Elders
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Graeme MacLennan
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Craig R Ramsay
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - John Norrie
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Jennifer M Burr
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Bruce Campbell
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Paul Bachoo
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Ian Chetter
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Michael Gough
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Jonothan Earnshaw
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Tim Lees
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Julian Scott
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Sara A Baker
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Emma Tassie
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Jill Francis
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
| | - Marion K Campbell
- From the Institute of Cardiovascular Research, University of Glasgow (J.B.), and the Institute of Applied Health Research, Nursing, Midwifery, and Allied Health Professions Research Unit, Glasgow Caledonian University (A.E.), Glasgow, the Health Services Research Unit (D.C., S.C.C., G.M., C.R.R., M.K.C.) and the Health Economics Research Unit (M.D., G.S., E.T.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen, the Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh (J.N.), the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J.M.B.), the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.), the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.), the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds, Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.), Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.), the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.), and the School of Health Sciences, City University of London, London (J.F.) - all in the United Kingdom
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Chernykh KP, Kubachev KG, Semenov AY, Malyshev KV. [Treatment of patients with lower limb varicose veins disease]. Khirurgiia (Mosk) 2019:88-93. [PMID: 31169826 DOI: 10.17116/hirurgia201905188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Modern data on the prevalence and pathophysiology of lower limb varicose disease are presented. The results of studies of modern approaches to the surgical correction of this state are demonstrated. Conclusions about the unresolved number of problems.
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Affiliation(s)
- K P Chernykh
- Municipal Aleksandrovskaya Hospital, st. petersburg, Russia
| | - K G Kubachev
- Mechnikov North-Western State Medical Universityl, st. petersburg, Russia
| | - A Yu Semenov
- Medical Innovation Phlebology Center, Moscow, Russia
| | - K V Malyshev
- Central Municipal Clinical Hospital #8, Kazan, Russia
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Novak CJ, Khimani N, Kaye AD, Jason Yong R, Urman RD. Current Therapeutic Interventions in Lower Extremity Venous Insufficiency: a Comprehensive Review. Curr Pain Headache Rep 2019; 23:16. [PMID: 30830460 DOI: 10.1007/s11916-019-0759-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Chronic venous disease (CVD), although affecting up to 40% of the US population, is often underdiagnosed by healthcare professionals due to an incomplete understanding of the presenting symptoms. CVD is a common cause of lower extremity pain and discomfort, including aching, cramping, tingling, burning, swelling, heaviness, restlessness, and fatigue, and may lead to significant morbidity if left untreated. The negative impact of CVD on quality of life is well established and the optimization of management strategies is an important area of evolving research. RECENT FINDINGS Management of CVD has rapidly evolved over the last two decades with the development of minimally invasive endovenous ablative techniques, now the mainstay of treatment. We discuss the data supporting various methods of CVD treatment with an emphasis on the impact on patient comfort and quality of life. Both radiofrequency ablation (RFA) and endovenous laser therapy (EVLA) are excellent options for treatment of lower extremity venous disease, but RFA is associated with less post-procedure discomfort. Ultrasound-guided foam therapy is best reserved for the adjuvant setting or for patients ineligible for RFA or EVLA.
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Affiliation(s)
| | - Namrata Khimani
- Vein Institute and Pain Centers of America, New York, NY, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - R Jason Yong
- Vein Institute and Pain Centers of America, New York, NY, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gohel MS, Heatley F, Davies AH. Endovenous Ablation in Venous Ulceration. N Engl J Med 2018; 379:1482-3. [PMID: 30304658 DOI: 10.1056/nejmc1811147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Zheng X, Wei Q, Zhang H. Novel Developments in Polidocanol Sclerotherapy: A Review. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/jbm.2018.68003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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