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Elzefzaf N, Elfeky MA, Elshatlawy KM, Abdelal A, Elhendawy A, Ahmed A, Nada M, Ouf T. Evaluation of Endovenous Laser Ablation in the Management of Varicose Veins. Cureus 2023; 15:e45096. [PMID: 37842441 PMCID: PMC10569145 DOI: 10.7759/cureus.45096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background The treatment of varicose veins has undergone tremendous changes over the years. High ligation of the saphenofemoral junction (SFJ) and stripping of the great saphenous vein (GSV) have been considered standard treatments for GSV insufficiency for over a century and are still adopted as the preferred method in the majority of surgical centers in North Africa. However, the increase in minimally invasive treatments such as endovenous thermal ablation (EVTA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy, and cryo-stripping has produced excellent results. Most patients who underwent these minimally invasive treatments were satisfied with their outcomes. Methodology and results In this clinical and prospective study, 30 cases (19 male and 11 female) of primary varicose veins underwent endovenous laser ablation (EVLA), and their outcomes were reviewed, and their results were satisfying to the patients. After EVLA with or without sclerotherapy, no major complications occurred (recurrence or recanalization) at the time of the study, although minor complications were quite common and included bruising or ecchymosis, postoperative pain that required analgesics, superficial thrombophlebitis, and skin burns that were very responsive to medical treatment. Conclusion Endovenous laser ablation continues to be a valid minimally invasive method for treating varicose veins with minimal complications and a very short recovery period, which appeals to patients.
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Affiliation(s)
- Nada Elzefzaf
- Vascular Surgery, Manchester Foundation Trust, Manchester, GBR
| | - Mohamed A Elfeky
- General and Colorectal Surgery, The Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Oldham, GBR
| | - Kareem M Elshatlawy
- Vascular Surgery, Menshawy General Hospital, Tanta, EGY
- Vascular Surgery, Alhada Military Hospital, Taif, SAU
| | - Ahmed Abdelal
- Vascular Surgery, Manchester Foundation Trust, Manchester, GBR
| | | | | | - Mohamed Nada
- General and Colorectal Surgery, Ain Shams University Hospitals, Cairo, EGY
| | - Tarek Ouf
- General and Colorectal Surgery, Ain Shams University Hospitals, Cairo, EGY
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Endovenous Laser Ablation for Varicose Vein Treatment: A Systematic Review and Meta-Analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03441-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Healy DA, Twyford M, Moloney T, Kavanagh EG. Systematic review on the incidence and management of endovenous heat-induced thrombosis following endovenous thermal ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord 2021; 9:1312-1320.e10. [PMID: 33618065 DOI: 10.1016/j.jvsv.2021.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis was performed to determine the incidence of endovenous heat-induced thrombosis (EHIT) and evaluate its management after endovenous thermal ablation of the great saphenous vein (GSV). METHODS MEDLINE and Embase were searched for studies with at least 100 patients who underwent great saphenous vein endovenous thermal ablation and had duplex ultrasound follow-up within 30 days. Data were gathered on the incidence of thrombotic complications and on the management of cases of EHIT. The primary outcome for the meta-analysis was EHIT types 2 to 4 and secondary outcomes were deep venous thrombotic events (which we defined as types 2-4 EHIT plus deep vein thrombosis [DVT]), DVT, and pulmonary embolism (PE). Pooled proportions were calculated using random effects modelling. RESULTS We included 75 studies (23,265 patients). EHIT types 2 to 4 occurred in 1.27% of cases (95% confidence interval [CI], 0.74%-1.93%). Deep venous thrombotic events occurred in 1.59% (95% CI, 0.95%-2.4%). DVT occurred in 0.28% (95% CI, 0.18%-0.4%). Pulmonary embolism occurred in 0.11% (95% CI, 0.06%-0.18%). Of the 75 studies, 24 gave a description of the management strategy and outcomes for EHIT and there was inconsistency regarding its management. Asymmetrical funnel plots of studies that reported incidence of EHIT 2 to 4 and DVT suggest publication bias. CONCLUSIONS The recently published guidelines on EHIT from the Society for Vascular Surgery/American Venous Forum provide a framework to direct clinical decision-making. EHIT and other thrombotic complications occur infrequently and have a benign course.
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Affiliation(s)
- Donagh A Healy
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Mark Twyford
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick School of Medicine, Limerick, Ireland
| | - Tony Moloney
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick School of Medicine, Limerick, Ireland.
| | - Eamon G Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick School of Medicine, Limerick, Ireland
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Aldhafery BF. What family physicians should know about interventional radiology? J Family Community Med 2020; 27:85-90. [PMID: 32831552 PMCID: PMC7415269 DOI: 10.4103/jfcm.jfcm_290_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/23/2020] [Accepted: 04/10/2020] [Indexed: 11/13/2022] Open
Abstract
Interventional radiology (IR) is a rapidly evolving specialty. The minimally invasive nature of the procedures has led to a paradigm shift in treating many disease processes from conventional surgery to interventional techniques that have become the first choice and the preferred method for the treatment of peripheral vascular disease, many aortic pathologies, and venous diseases. Interventional oncology procedures have become widely available for the treatment of solid hepatic and renal tumors. This includes palliative techniques for many advanced malignancies, and fluid drainage that is exclusively performed by interventional radiologists in many hospitals all around the world. Women's health-related procedures such as uterine fibroid embolization, fallopian tube recanalization, and embolization for pelvic congestion syndrome have become attractive choices for many patients. Family physicians (FPs) are the main source of patient referral to hospitals. However, there is a notable knowledge deficiency of IR among FPs in Saudi Arabia. This may be due to poor communication between FP and IR or the lack of FP's awareness of IR procedures. This is a nonsystematic review to introduce some IR procedures to FPs pertinent to their practice to optimize patient referral and management with the use of IR services. We focused on the most commonly performed IR procedures paying special attention to their clinical indications, benefits, and alternatives.
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Affiliation(s)
- Bander F Aldhafery
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Lee QWS, Gibson K, Chan SL, Rathnaweera HP, Chong TT, Tang TY. A comparison between Caucasian and Asian superficial venous anatomy and reflux patterns – Implications for potential precision endovenous ablation therapy. Phlebology 2019; 35:39-45. [DOI: 10.1177/0268355519845984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives The aim of this study is to investigate whether there are differences between predominantly Caucasians and Asians from two disparate cohorts around the globe, with regard to their pre-operative venous reflux patterns and truncal vein characteristics, which could potentially help clinicians tailor venous treatment for chronic venous insufficiency on a more individualised basis in different parts of the world. Methods A total of 200 lower limb chronic venous insufficiency duplex studies (127 Singaporean (predominantly Asian) patients) and 200 lower limb chronic venous insufficiency duplex scans (137 Americans predominantly Caucasians) were analysed and compared for differences in venous anatomy and reflux characteristics. Results Asian patients from Singapore presented with higher CEAP scores compared to the predominantly Caucasian cohort from the US (30% CEAP 4a or greater vs. 17.5%; p < 0.01). Singaporeans had more great saphenous vein reflux starting at the sapheno-femoral junction (86% vs. 73%; p < 0.01) and ending at the ankle (93% vs. 46%; p < 0.01). Vein diameters were generally larger in the US cohort of patients (median 5.7 mm vs. 2.9 mm; p < 0.01). Conclusions The predominantly Asian cohort from Singapore had smaller diameter truncal veins, longer segments of truncal vein reflux and present later with more advanced chronic venous insufficiency compared to their American counterparts. This information could help tailor endovenous ablation on a more individualised basis in the future.
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Affiliation(s)
- QWS Lee
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
| | - K Gibson
- Lake Washington Vascular Surgeons, Bellevue, WA, USA
| | - SL Chan
- Health Services Research Center, SingHealth, Singapore, Singapore
| | - HP Rathnaweera
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - TT Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
| | - TY Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
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Healy DA, Kimura S, Power D, Elhaj A, Abdeldaim Y, Cross KS, McGreal GT, Burke PE, Moloney T, Manning BJ, Kavanagh EG. A Systematic Review and Meta-analysis of Thrombotic Events Following Endovenous Thermal Ablation of the Great Saphenous Vein. Eur J Vasc Endovasc Surg 2018; 56:410-424. [DOI: 10.1016/j.ejvs.2018.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/04/2018] [Indexed: 01/17/2023]
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Side effects and occlusion rate after tumescentless treatment of the great saphenous vein with EVLA. PHLEBOLOGIE 2018. [DOI: 10.12687/phleb2254-2-2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
SummaryWe have performed a retrospective analysis of side-effect profile of endovenous laser ablation (EVLA) of great saphenous veins in patients operated on in general sedation or general/regional anesthesia with or without tumescence solution injection. The results confirmed our initial assumptions that omitting tumescence (and in addition, avoiding any external compression and cooling) may actually significantly reduce the incidence of moderate/severe postoperative pain and brusing without compromising closure rates. As these are probably caused by vessel wall perforations they seem to be more common in the tumescence cohort. The results are in line with recent basic research which showed that fiber tip centering may reduce perforations (easier to perform in vessels filled with blood), that blood itself does not either reduce or enhance laser‘s effect, and that various lasers over a wide range of wavelengths (from hemoglobin-absorbing to water-absorbing) have comparable clinical efficacy. Hence, omitting tumescence and external compression probably reduces the incidence of postoperative pain and brusing in patients treated with EVLA.
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Nguyen T, Bergan J, Min R, Morrison N, Zimmet S. Curriculum of the American College of Phlebology. Phlebology 2016. [DOI: 10.1258/026835506779613534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- T Nguyen
- Dermatology, Mohs Micrographic & Dermatologic surgery, Procedural Dermatology, University of Texas-MD Anderson Cancer Center, Houston, TX, USA
| | - J Bergan
- Department of Surgery, UCSD School of Medicine, San Diego, CA, USA
| | - R Min
- Department of Radiology, Cornell University School of Medicine, New York, NY, USA
| | - N Morrison
- Morrison Vein Institute, Scottsdale AZ, USA
| | - S Zimmet
- Zimmet Vein and Dermatology, Austin, TX, USA
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Woźniak W, Mlosek RK, Ciostek P. Complications and Failure of Endovenous Laser Ablation and Radiofrequency Ablation Procedures in Patients With Lower Extremity Varicose Veins in a 5-Year Follow-Up. Vasc Endovascular Surg 2016; 50:475-483. [PMID: 27681171 DOI: 10.1177/1538574416671247] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Thermal ablation techniques have gradually replaced Babcock procedure in varicose vein treatment. AIM A comparative quantitative-qualitative analysis of complications and failure of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in a 5-year follow-up. MATERIALS AND METHODS One hundred ten adult participants with varicose veins clinical grade C2 to C6, treated for isolated great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency in a single lower extremity in 2009 to 2010, were enrolled and subdivided into EVLA (n = 56) and RFA (n = 54) groups. Both groups were compared for demography, disease stage, affected veins, perioperative, and postoperative complications as well as treatment efficacy. RESULTS The perioperative and postoperative complications were statistically insignificant. Treatment efficacy, expressed as the number of participants with recurrent varicosity and recanalization, was comparable in both groups. The clinically significant recanalization rate was 3.6% and 5.6% in EVLA and RFA groups, respectively. CONCLUSION Endovenous laser ablation and RFA for the management of lower extremity varicose vein offer comparable efficacy and safety in a 5-year follow-up.
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Affiliation(s)
- Witold Woźniak
- First Department of General and Vascular Surgery, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - R Krzysztof Mlosek
- Department of Diagnostic Imaging, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Ciostek
- First Department of General and Vascular Surgery, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
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Go SJ, Cho BS, Mun YS, Kang YJ, Ahn HY. Study on the Long-Term Results of Endovenous Laser Ablation for Treating Varicose Veins. Int J Angiol 2016; 25:117-20. [PMID: 27231428 DOI: 10.1055/s-0035-1555749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background Endovenous laser ablation (EVLA) is widely performed since the early 2000s, but there are few long-term results. Objectives The aim of this study was to evaluate the long-term results of EVLA employed for treating varicose veins of the lower limbs by duplex ultrasonographic study. Methods A total of 24 limbs of 17 patients who underwent EVLA between 2004 and 2007 were examined with duplex ultrasonographic scans. The mean follow-up period was 66.1 months. Results There were five recurrences of saphenofemoral junction reflux. The occlusion rate was 79.2% at a mean follow-up of 66.1 months. There were 14 recanalizations and 5 recurrences of the great saphenous vein. Five partial and nine total recanalizations were observed. Conclusions EVLA is an effective and minimally invasive treatment for varicose veins. Our long-term result was acceptable, but the result was not outstanding.
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Affiliation(s)
- Seung Je Go
- Department of Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Byung Sun Cho
- Department of Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yun Su Mun
- Department of Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Yoon Jung Kang
- Department of Surgery, Eulji University Hospital, Daejeon, South Korea
| | - Hye Young Ahn
- Eulji University College of Nursing, Daejeon, South Korea
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Galego GDN, Lima GBB, Franklin RN, Bortoluzzi CT, Silveira PG. Outcome of 1470nm laser diode ablation for superficial venous insufficiency. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Endovenous laser ablation is a minimally invasive procedure that can be used to treat superficial venous insufficiency. We believe that using a longer wavelength will reduce the frequency of the most common adverse effects associated with the use of shorter wavelengths.OBJECTIVES: To report the results of an initial series of patients with chronic superficial venous insufficiency treated using a 1470 nanometer diode laser and to compare results using linear and radial laser fibers.METHODS: We conducted an observational cohort study. Seventy-four patients, for whom at least two postoperative Doppler ultrasonography scans were available, were recruited with a total of 121 saphenous veins treated (92 great and 29 small saphenous veins). There were 57 patients in Group A (treated with the linear fiber) and 17 in Group B (radial fiber). Follow-up ideally comprised clinical consultation and Doppler ultrasonography at 1 month, 6 months and 12 months after the procedure. Success was defined as total occlusion of the venous segment that had been treated.RESULTS: Success rates at mean follow-up of 13.4 months (range 7 - 27) were 83% for great saphenous veins and 89% for small saphenous veins. Patients treated with the radial fiber required less energy to achieve occlusion of the small saphenous vein and exhibited fewer adverse reactions, with statistical significance.CONCLUSIONS: Treatment of great and small saphenous vein insufficiency using the 1470 nm diode laser is safe and effective. The radial fiber was associated with fewer intercurrent conditions than the linear fiber, although success rates were similar.
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Joh JH, Kim WS, Jung IM, Park KH, Lee T, Kang JM. Consensus for the Treatment of Varicose Vein with Radiofrequency Ablation. Vasc Specialist Int 2014. [PMID: 26217628 PMCID: PMC4480318 DOI: 10.5758/vsi.2014.30.4.105] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2–20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis ≥class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles’ ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
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Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Woo-Shik Kim
- Department of Cardiothoracic Surgery, National Medical Center, Seoul
| | - In Mok Jung
- Department of Surgery, SVU-SMG Boramae Medical Center, Seoul
| | - Ki-Hyuk Park
- Department of Surgery, Daegu Catholic University Medical Center, Daegu
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Jin Mo Kang
- Department of Vascular Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Alder LS, Rahi MA. Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins. Ann R Coll Surg Engl 2014; 96:279-83. [PMID: 24780019 DOI: 10.1308/003588414x13814021679474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Endovenous ablation of saphenous varicose veins has decreased morbidity and recovery time compared with open surgery. This study assessed the outcome and mid-term patient satisfaction of single-visit endovenous laser treatment (EVLT) alone, EVLT combined with phlebectomies and endovenous chemical ablation. METHODS A retrospective review was conducted of all patients (n=91) in 2008-2009 who underwent single-visit day-case EVLT using local anaesthesia under a single surgeon. Postoperative venous ultrasonography at 2 and 14 months was reviewed. A telephone questionnaire was carried out to assess recurrence of symptoms and quality of life at 42 months. RESULTS Overall, 124 limbs underwent day-case EVLT under local anaesthesia using an 810nm diode laser at a continuous setting of 14W. Forty-eight of these underwent EVLT alone while fifty underwent EVLT with phlebectomies and twenty-six underwent EVLT with endovenous chemical ablation. Ninety-one per cent of limbs underwent two-month postoperative imaging. All had satisfactory great saphenous vein (GSV) ablation (anterior thigh vein patency: n=1). The majority (84%) of limbs underwent 14-month imaging with a 98% GSV ablation rate. Three per cent had anterior thigh vein and saphenofemoral junction incompetence. Recurrence of GSV patency and reflux was <1%. The response rate to the questionnaire was 60%: 95% of respondents confirmed improvement following treatment, 62% remained symptom free at 42 months while 65% of patients with a return of symptoms deemed them mild. The questionnaire was scored out of 56 for symptoms and quality of life. Those with symptoms scored significantly higher. CONCLUSIONS At 42 months, the majority of limbs remained asymptomatic. The short-term GSV ablation rates were excellent. Overall mid-term review of patients has shown a well received single-visit service with concomitant phlebectomy or endovenous ablation, and good ablation and patient satisfaction rates.
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Affiliation(s)
- L S Alder
- East Lancashire Hospitals NHS Trust, UK
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van Eekeren RR, Boersma D, de Vries JPP, Zeebregts CJ, Reijnen MM. Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature. Semin Vasc Surg 2014; 27:118-36. [DOI: 10.1053/j.semvascsurg.2015.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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von Hodenberg E, Zerweck C, Knittel M, Zeller T, Schwarz T. Endovenous laser ablation of varicose veins with the 1470 nm diode laser using a radial fiber – 1-year follow-up. Phlebology 2013; 30:86-90. [DOI: 10.1177/0268355513512825] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Endovenous laser ablation is one of the most accepted treatment options for insufficient great and small saphenous veins. The aim of this study was to investigate the long-term efficacy and safety of the radial fiber (ELVeS-radial kit™) for the 1470 nm diode laser in a 1-year follow-up. Methods: A total of 308 lower limbs with primary insufficiency of great and small saphenous veins or insufficient tributaries were included in the prospective observational cohort study. The primary efficacy endpoint of the study was ultrasonographic proven elimination of venous reflux after at least 1 year. Secondary efficacy and further safety end points after 1 year were as follows: (1) sonographic exclusion of recanalization of the treated vein segments, (2) deep vein thrombosis, clinical pulmonary embolism or superficial vein thrombosis as defined by objective testing, (3) death from any cause, (4) persistent clinical complaints such as pain and paresthesia, (5) recurrent varicose veins. Patient satisfaction was assessed using a CIVIQ-2 questionnaire after 1 year. Results: Follow-up could be completed in 91.2% of the patients. Excellent efficacy numbers with 99.6% occlusion of the treated varicose veins as elimination of reflux could be demonstrated. After 1 year, 96% of the treated veins disappeared completely sonographically; one recanalization was observed. No deep vein thrombosis or pulmonary embolism occurred, three superficial vein thrombosis were diagnosed in follow-up examinations. Four patients died, not related to pulmonary embolism. No persistent pain or paresthesia occurred in the follow-up. Recurrent varicose veins were diagnosed in 10 patients (2.81%). Conclusion: One-year follow-up showed that endovenous laser treatment of varicose veins with 1470 nm diode laser using the radial fiber is highly effective, also regarding in a 1-year follow-up.
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Affiliation(s)
- E von Hodenberg
- Department of Cardiology and Angiology II, Universitaets-Herzzentrum, Freiburg, Bad Krozingen, Germany
| | - C Zerweck
- Department of Cardiology and Angiology II, Universitaets-Herzzentrum, Freiburg, Bad Krozingen, Germany
| | - M Knittel
- Department of Cardiology and Angiology II, Universitaets-Herzzentrum, Freiburg, Bad Krozingen, Germany
| | - T Zeller
- Department of Cardiology and Angiology II, Universitaets-Herzzentrum, Freiburg, Bad Krozingen, Germany
| | - T Schwarz
- Department of Cardiology and Angiology II, Universitaets-Herzzentrum, Freiburg, Bad Krozingen, Germany
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Randomized Clinical Trial of Endovenous Microwave Ablation Combined with High Ligation Versus Conventional Surgery for Varicose Veins. Eur J Vasc Endovasc Surg 2013; 46:473-9. [DOI: 10.1016/j.ejvs.2013.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/05/2013] [Indexed: 11/15/2022]
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Thompson R, Lewis A, Weir C. Patient-reported quality-of-life after radiofrequency ablation of varicose veins compared to conventional surgery. Ir J Med Sci 2013; 182:639-42. [PMID: 23543415 DOI: 10.1007/s11845-013-0944-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/18/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare patient-reported quality-of-life scores after radiofrequency ablation (RFA) compared to conventional surgery using the Aberdeen Varicose Vein Questionnaire (AVVQ). METHODS A postal questionnaire based on the AVVQ was sent out to 105 patients who underwent RFA and 50 patients who underwent surgery for varicose veins in our unit over a 14-month period. Responses were analysed according to sex and compared between the two groups to determine if there is a difference in the patient-reported quality-of-life scores. The mean AVVQ was calculated for both groups. RESULTS Responses were received from 57 patients who underwent RFA and 27 patients who had surgery. In the domains of itch, discolouration, analgesia use, ankle swelling, cosmetic concern due to their varicose veins and reporting that their varicose veins affect their choice of clothing, there was a statistically significant difference favouring RFA in female patients. Conversely, in men, there was a statistically significant difference in favour of conventional surgery in the domains of pain, itch, analgesia use, cosmetic concern, affecting choice of clothing and affecting daily activities. There was no statistically significant difference in the mean AVVQ scores. CONCLUSIONS This study has shown that for the female patients in our patient population, RFA results in generally better quality-of-life scores than conventional surgery when assessed using the disease-specific AVVQ. In this cohort, there was a statistically significant difference favouring conventional surgery in men. A number of potentially confounding variables have been discussed.
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Affiliation(s)
- R Thompson
- Craigavon Area Hospital, 68 Lurgan Road, Portadown, BT63 5QQ, Craigavon, Northern Ireland,
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Rosales-Velderrain A, Gloviczki P, Said SM, Hernandez MT, Canton LG, Kalra M. Pulmonary embolism after endovenous thermal ablation of the saphenous vein. Semin Vasc Surg 2013; 26:14-22. [DOI: 10.1053/j.semvascsurg.2013.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dzieciuchowicz Ł, Krasiński Z, Kruszyna Ł, Espinosa G. Assessment of the level of difficulty of four techniques of endovenous thermal ablation of the great saphenous vein and the echogenicity of the tip of the working device in vivo. Ann Vasc Surg 2012; 27:322-8. [PMID: 23088807 DOI: 10.1016/j.avsg.2012.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/29/2012] [Accepted: 04/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND To compare the level of difficulty of four techniques of endovenous thermal ablation (EVTA) of the great saphenous vein and the echogenicity of the tip of the working device in vivo. METHODS Sixty patients qualified to the EVTA of the great saphenous vein were randomly assigned to treatment with an 810-nm axial diode laser [endovenous laser ablation (EVLA) 810] with two different delivery systems: 4-F introducer, 0.018" guidewire, 22-G needle (EVLA810-1) and 4-F introducer, 0.035" guidewire, 19-G needle (EVLA810-2); a 1470-nm radial diode laser (EVLA1470); or radiofrequency ablation (RFA; ClosureFAST). The level of difficulty of four stages of the procedure-cannulation of a vein, advancement of the working part to the saphenofemoral junction (SFJ), visualization of a tip of the working part at SFJ, and difficulty of performing the ablation and delivering the planned linear energy density-was subjectively assessed. An objective comparison of visibility of working parts in ultrasonography was performed with analysis of grayscale median. RESULTS The cannulation of a distal segment of the obliterated vein was the most difficult in EVLA810-1, P = 0.015. The delivery of a working part to the SFJ was the least problematic in RFA and EVLA1470, P = 0.024. The visualization of the working tip at the SFJ was the most difficult in RFA, P = 0.028. The application of desired amount of energy was the easiest in RFA, P = 0.038. The EVLA1470 presented the best echogenicity. CONCLUSIONS Although all the examined techniques have advantages and disadvantages, EVTA with the 1470-nm diode laser with radial optic fiber seems to be the easiest.
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Affiliation(s)
- Łukasz Dzieciuchowicz
- Department of Angiology and Vascular Surgery, Navarra University Hospital, Pamplona, Spain
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21
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Changing to endovenous treatment for varicose veins: How much more evidence is needed? Surgeon 2011; 9:150-9. [DOI: 10.1016/j.surge.2010.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/30/2010] [Accepted: 11/02/2010] [Indexed: 11/18/2022]
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A Prospective Comparison of Four Methods of Endovenous Thermal Ablation. POLISH JOURNAL OF SURGERY 2011; 83:597-605. [DOI: 10.2478/v10035-011-0095-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ghauri ASK, Nyamekye IK. Leg ulceration: the importance of treating the underlying pathophysiology. Phlebology 2010; 25 Suppl 1:42-51. [DOI: 10.1258/phleb.2010.010s07] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The last 20 years have seen considerable advances in the management of vascular diseases both in non-invasive imaging and minimally invasive surgical interventions. Colour duplex ultrasonography provides non-invasive and increasingly high-resolution anatomic and haemodynamic vascular information. This has been complimented by the development of minimally invasive interventional procedures such as subintimal angioplasty and endovenous treatments, all of which can be performed under local anaesthesia. These advances can now be utilized to improve both the assessment and management of patients with chronic leg ulceration where the aetiology is usually vascular and mostly primary venous insufficiency. Using non-invasive Doppler pressures and colour duplex imaging, the anatomic and haemodynamic pattern of the underlying vascular disease (and consequently the pathophysiology) can be precisely determined. This enables appropriate planning and targeting of effective management from an early stage in the history of any particular ulcer. This paper highlights the importance of achieving accurate diagnosis and instituting effective treatments that are appropriately targeted at the underlying pathophysiology, in patients with chronic leg ulceration, and describes how recent advances in technology and interventions have substantially increased the tools available to the vascular specialist. Thus allowing safe and effective management of what can otherwise become a prolonged or recurrent disease process.
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Affiliation(s)
- A S K Ghauri
- Salisbury District Hospital, Odstock Road, Salisbury
| | - I K Nyamekye
- Worcectershire Royal Hospital, Charles Hastings Way, Worcester, UK
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Schwarz T, von Hodenberg E, Furtwängler C, Rastan A, Zeller T, Neumann FJ. Endovenous laser ablation of varicose veins with the 1470-nm diode laser. J Vasc Surg 2010; 51:1474-8. [DOI: 10.1016/j.jvs.2010.01.027] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 01/06/2010] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
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Sroka R, Weick K, Sadeghi-Azandaryani M, Steckmeier B, Schmedt CG. Endovenous laser therapy--application studies and latest investigations. JOURNAL OF BIOPHOTONICS 2010; 3:269-76. [PMID: 20151443 DOI: 10.1002/jbio.200900097] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Endovenous laser therapy (ELT) was introduced in clinical practice as a therapy for incompetent veins about ten years ago. One characteristic of ELT is the broad spectrum of different treatment protocols by means of a variety of laser systems as well as manifold application forms and dosimetry concepts are under investigations. Clinical results with effective, relatively pain-free occlusion of incompetent varicosis veins have been observed, as well as undesired side effects such as ecchymosis, phlebitis and recanalization. In recent years systematic experimental investigations and the analysis of clinical results have increased the understanding of the interrelation between the clinical and physical aspects, followed to a continuous optimization of ELT. The use of IR wavelengths and radial irradiation concepts, together with continuous moving of the optical fiber seem to reduce possible side effects. This way ELT treatment becomes a more standardized effective method for the treatment of varicose veins. In future controlled randomized studies are required to compare optimized ELT treatment with other endoluminal modalities as well as conventional surgery.
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Affiliation(s)
- Ronald Sroka
- Laser-Forschungslabor im LIFE-Zentrum der LMU München, München, Germany.
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26
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Schmedt CG, Sroka R, Sadeghi M, Steckmeier B, Hupp T. Neue Entwicklungen der endovenösen Lasertherapie. GEFÄSSCHIRURGIE 2010. [DOI: 10.1007/s00772-009-0759-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Desmyttère J, Grard C, Stalnikiewicz G, Wassmer B, Mordon S. Endovenous Laser Ablation (980nm) of the Small Saphenous Vein in a Series of 147 Limbs with a 3-Year Follow-up. Eur J Vasc Endovasc Surg 2010; 39:99-103. [DOI: 10.1016/j.ejvs.2009.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 09/20/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Endovenous laser ablation (EVLA) is a new minimally invasive alternative to conventional surgery for superficial venous insufficiency and varicose veins, where laser energy is used to ablate the incompetent veins. DISCUSSION Endovenous laser ablation avoids the need for surgical incisions, and the complications of surgical exploration of the groin or popliteal fossa, and stripping. The procedure is commonly performed under local anaesthesia, with immediate mobilisation and rapid return to normal activity. Severe varicosity of tributaries may require adjunctive procedures such as microphlebectomy or sclerotherapy. CONCLUSION Early outcomes and cosmesis are superior, and long-term data is accumulating that recurrence of EVLA rates may be lower.
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Affiliation(s)
- R Durai
- Department of Vascular and Endovascular Surgery, Barts and the London NHS Trust, The Royal London Hospital, London, UK
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Lugli M, Cogo A, Guerzoni S, Petti A, Maleti O. Effects of eccentric compression by a crossed-tape technique after endovenous laser ablation of the great saphenous vein: a randomized study. Phlebology 2009; 24:151-6. [PMID: 19620697 DOI: 10.1258/phleb.2008.008045] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the effect of eccentric compression applied by a new crossed-tape technique on procedure-related pain occurrence after endovenous laser ablation (ELA) of the great saphenous vein (GSV). METHODS From April 2005 to June 2006, 200 consecutive ELA procedures were randomized to receive (group A: 100) or not (group B: 100) an eccentric compression applied in the medial aspect of the thigh. Patients were scheduled for a seven-day examination to assess the level of pain experienced. Pain intensity was measured using a visual analogue scale giving a numerical grade from 0 (no pain) to 10 (worst pain ever). RESULTS The intensity of postoperative pain was significantly reduced (P < 0.001) in the eccentric compression group as compared with the non-compression one. CONCLUSIONS This technique of eccentric compression greatly reduces the intensity of postoperative pain after ELA of the GSV.
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Affiliation(s)
- M Lugli
- Hesperia Hospital - CardioVascular Surgery, Via Arquà 80/A, Modena 41100, Italy.
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Parnaby CN, Welch GH, Stuart WP. An overview of the surgical aspects of lower limb venous disease. Scott Med J 2009; 54:30-5. [PMID: 19725280 DOI: 10.1258/rsmsmj.54.3.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lower limb venous disease encompasses a wide spectrum of pathology, the importance of which relates to high prevalence rather than mortality. The complications of chronic venous insufficiency (CVI), namely lipodermatosclerosis and chronic venous ulceration, represent a major burden to healthcare providers and a high degree of personal morbidity for patients. Management is based upon accurate clinical diagnosis supported by non-invasive imaging. Open surgical and minimally invasive techniques are used to treat varicose veins. Chronic skin complications of CVI require a multidisciplinary approach.
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Affiliation(s)
- C N Parnaby
- Department of Surgery, Southern General Hospital, Glasgow.
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31
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van den Bos RR, Neumann M, de Roos KP, Nijsten T. Endovenous Laser Ablation–Induced Complications: Review of the Literature and New Cases. Dermatol Surg 2009; 35:1206-14. [DOI: 10.1111/j.1524-4725.2009.01215.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Trip-Hoving M, Verheul JC, van Sterkenburg SM, de Vries WR, Reijnen MM. Endovenous Laser Therapy of the Small Saphenous Vein: Patient Satisfaction and Short-Term Results. Photomed Laser Surg 2009; 27:655-8. [DOI: 10.1089/pho.2008.2389] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Margreet Trip-Hoving
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Jorieke C. Verheul
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Steven M.M. van Sterkenburg
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Willem R. de Vries
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
| | - Michel M.P.J. Reijnen
- Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
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Darwood RJ, Gough MJ. Endovenous laser treatment for uncomplicated varicose veins. Phlebology 2009; 24 Suppl 1:50-61. [DOI: 10.1258/phleb.2009.09s006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective Endovenous laser ablation (EVLA) of incompetent truncal veins has been proposed as a minimally invasive alternative to conventional surgery for varicose veins. Various strategies have been proposed for successful treatment and this study reviews the evidence for these. Method A Medline and ‘controlled trials online database’ search was performed to identify original articles and randomized controlled trials (RCTs) reporting outcomes for EVLA. Information on patient selection, equipment, technique and outcomes were recorded. Results Ninety-eight original studies, including five RCTs, were identified. RCT data indicate short-term outcomes (abolition of reflux, improvement in quality of life [QOL], patient satisfaction) were equivalent to those for surgery. Long-term follow-up is not available. A further RCT showed superior outcomes for ablation commencing at the lowest point of superficial venous reflux rather than at an arbitrary point (fewer residual varicosities, greater improvement in QOL). Non-randomized series suggest that laser energy of >60 J/cm results in reliable truncal vein occlusion and that longer wavelength lasers may be associated with less post-treatment discomfort. Conclusion In the short-term EVLA is a safe and effective treatment for patients with varicose veins. Long-term follow-up is still required.
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Affiliation(s)
- R J Darwood
- Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, UK
| | - M J Gough
- Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, UK
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Hoggan B, Cameron A, Maddern G. Systematic Review of Endovenous Laser Therapy Versus Surgery for the Treatment of Saphenous Varicose Veins. Ann Vasc Surg 2009; 23:277-87. [DOI: 10.1016/j.avsg.2008.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/06/2008] [Accepted: 11/06/2008] [Indexed: 11/17/2022]
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35
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Nijsten T, van den Bos RR, Goldman MP, Kockaert MA, Proebstle TM, Rabe E, Sadick NS, Weiss RA, Neumann MH. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol 2009; 60:110-9. [DOI: 10.1016/j.jaad.2008.07.046] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 06/09/2008] [Accepted: 07/27/2008] [Indexed: 10/21/2022]
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36
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Traditional versus Endoscopic Saphenous Vein Stripping: A Prospective Randomized Pilot Trial. Eur J Vasc Endovasc Surg 2008; 36:611-5. [DOI: 10.1016/j.ejvs.2008.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 06/22/2008] [Indexed: 11/20/2022]
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Proebstle TM, Vago B, Alm J, Göckeritz O, Lebard C, Pichot O. Treatment of the incompetent great saphenous vein by endovenous radiofrequency powered segmental thermal ablation: First clinical experience. J Vasc Surg 2008; 47:151-156. [DOI: 10.1016/j.jvs.2007.08.056] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 08/15/2007] [Accepted: 08/31/2007] [Indexed: 11/16/2022]
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Sharif MA, Lau LL, Lee B, Hannon RJ, Soong CV. Role of endovenous laser treatment in the management of chronic venous insufficiency. Ann Vasc Surg 2007; 21:551-5. [PMID: 17823037 DOI: 10.1016/j.avsg.2007.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 04/26/2007] [Accepted: 07/16/2007] [Indexed: 10/21/2022]
Abstract
Endovenous laser therapy (EVLT) is a recognized option in the treatment of uncomplicated varicose veins. This uncontrolled case series evaluates its effectiveness in the management of chronic venous insufficiency. Patients with a history of active or healed ulcers were selected for EVLT. The procedure was carried out in an outpatient setting over a period of 12 months. Assessment was carried out for evidence of ulcer healing and recurrence, long saphenous vein occlusion, and patient satisfaction at 3, 12, and 22 months. Results are expressed as means with range. EVLT was used to treat 23 limbs in 20 patients with a median age of 59 years (range 32-76) including 12 females and eight males. All patients had evidence of chronic venous insufficiency, graded at C5 or greater on the CEAP classification (C5 16, C6 7). Patients with long saphenous vein insufficiency were included, whereas those with either deep or combined deep and superficial venous incompetence were excluded. The cumulative 3-, 12-, and 22-month healing rates were 87% (20/23), 100% (23/23), and 95% (21/22), respectively. The only patient having a recurrence of ulcers at 22 months' follow-up (CEAP 6) had mid-calf perforator incompetence with recanalized long saphenous vein. Duplex scan demonstrated long saphenous vein occlusion in 100% (23/23), 96% (22/23), and 91% (20/22) at 3, 12, and 22 months, respectively. In all, 84% (16/19) of patients were satisfied with the results of treatment without any major procedure-related complication. These results demonstrate that EVLT, carried out in an outpatient setting, is effective in the treatment and prevention of chronic venous ulcers, with good patient satisfaction and no major complication.
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Affiliation(s)
- M A Sharif
- Department of Vascular and Endovascular Surgery, Belfast City Hospital, Belfast, Northern Ireland, UK.
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39
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Desmyttère J, Grard C, Wassmer B, Mordon S. Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients. J Vasc Surg 2007; 46:1242-7. [DOI: 10.1016/j.jvs.2007.08.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 08/14/2007] [Accepted: 08/18/2007] [Indexed: 10/22/2022]
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40
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Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg 2007; 35:88-95. [PMID: 17920307 DOI: 10.1016/j.ejvs.2007.08.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 08/09/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the last decade, several new treatments of truncal varicose veins have been introduced. Of these new therapies, endovenous laser therapy (EVLT) is one of the most widely accepted and used treatment options for incompetent greater and lesser saphenous veins. OBJECTIVE The objective of this report is to inform clinicians about the EVLT procedure and to review its efficacy and safety in treatment of truncal varicose veins. Also, we discuss some of the underlying theoretical principles and laser parameters that affect EVLT. METHODS We carried out a literature review of EVLT;s efficacy and safety. We included reports that included 100 or more limbs with a follow-up of at least 3 months. The principals and procedure of EVLT are described. Of the laser parameters, mode of administration, wavelength, fluence, wattage and pullback speed are discussed. CONCLUSION EVLT appears to be a very effective and safe option in the treatment of varicose veins but large randomized comparative studies are needed.
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41
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Mordon SR, Wassmer B, Zemmouri J. Mathematical modeling of 980-nm and 1320-nm endovenous laser treatment. Lasers Surg Med 2007; 39:256-65. [PMID: 17252577 DOI: 10.1002/lsm.20476] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Endovenous laser treatment (ELT) has been proposed as an alternative in the treatment of reflux of the great saphenous vein (GSV) and small saphenous vein (SSV). Numerous studies have since demonstrated that this technique is both safe and efficacious. ELT was presented initially using diode lasers of 810 nm, 940 nm, and 980 nm. Recently, a 1,320-nm Nd:YAG laser was introduced for ELT. This study aims to provide mathematical modeling of ELT in order to compare 980 nm and 1,320 nm laser-induced damage of saphenous veins. STUDY DESIGN/MATERIALS AND METHODS The model is based on calculations describing light distribution using the diffusion approximation of the transport theory, the temperature rise using the bioheat equation, and the laser-induced injury using the Arrhenius damage model. The geometry to simulate ELT was based on a 2D model consisting of a cylindrically symmetric blood vessel including a vessel wall and surrounded by an infinite homogenous tissue. The mathematical model was implemented using the Macsyma-Pdease2D software (Macsyma, Inc., Arlington, MA). Calculations were performed so as to determine the damage induced in the intima tunica, the externa tunica and inside the peri-venous tissue for 3 mm and 5 mm vessels (considered after tumescent anesthesia) and different linear endovenous energy densities (LEED) usually reported in the literature. RESULTS Calculations were performed for two different vein diameters: 3 mm and 5 mm and with LEED typically reported in the literature. For 980 nm, LEED: 50 to 160 J/cm (CW mode, 2 mm/second pullback speed, power: 10 W to 32 W) and for 1,320 nm, LEED: 50 to 80 J/cm (pulsed mode, pulse duration 1.2 milliseconds, peak power: 135 W, repetition rate 30 Hz to 50 Hz). DISCUSSION AND CONCLUSION Numerical simulations are in agreement with LEED reported in clinical studies. Mathematical modeling shows clearly that 1,320 nm, with a better absorption by the vessel wall, requires less energy to achieve wall damage. In the 810-1,320-nm range, blood plays only a minor role. Consequently, the classification of these lasers into hemoglobin-specific laser wavelengths (810, 940, 980 nm) and water-specific laser wavelengths (1,320 nm) is inappropriate. In terms of closure rate, 980 nm and 1,320 nm can lead to similar results and, as reported by the literature, to similar side effects. This model should serve as a useful tool to simulate and better understand the mechanism of action of the ELT.
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Affiliation(s)
- Serge R Mordon
- INSERM (French National Institute of Health and Medical Research), Lille University Hospital, Lille, France.
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42
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Gohel MS, Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, Heather BP, Mitchell DC, Whyman MR, Poskitt KR. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ 2007; 335:83. [PMID: 17545185 PMCID: PMC1914523 DOI: 10.1136/bmj.39216.542442.be] [Citation(s) in RCA: 240] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression. DESIGN Randomised controlled trial. SETTING Specialist nurse led leg ulcer clinics in three UK vascular centres. PARTICIPANTS 500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux. INTERVENTIONS Compression alone or compression plus saphenous surgery. MAIN OUTCOME MEASURES Primary outcomes were ulcer healing and ulcer recurrence. The secondary outcome was ulcer free time. RESULTS Ulcer healing rates at three years were 89% for the compression group and 93% for the compression plus surgery group (P=0.73, log rank test). Rates of ulcer recurrence at four years were 56% for the compression group and 31% for the compression plus surgery group (P<0.01). For patients with isolated superficial reflux, recurrence rates at four years were 51% for the compression group and 27% for the compress plus surgery group (P<0.01). For patients who had superficial with segmental deep reflux, recurrence rates at three years were 52% for the compression group and 24% for the compression plus surgery group (P=0.04). For patients with superficial and total deep reflux, recurrence rates at three years were 46% for the compression group and 32% for the compression plus surgery group (P=0.33). Patients in the compression plus surgery group experienced a greater proportion of ulcer free time after three years compared with patients in the compression group (78% v 71%; P=0.007, Mann-Whitney U test). CONCLUSION Surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time. TRIAL REGISTRATION Current Controlled Trials ISRCTN07549334 [controlled-trials.com].
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Affiliation(s)
- Manjit S Gohel
- Cheltenham General Hospital, Cheltenham, Gloucester GL53 7AN
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Abstract
The classic varicose vein operation still represents the "gold standard" in the operative therapy of varicose veins. The results of this procedure in view of perioperative complications are very good, with the incidence of perioperative deep venous thrombosis varying between 0.05% and 0.1%. Recurrence rates between 6% and 60% are published. However, the true recurrence rate is unknown since an exact definition of recurrent varicosis is still lacking. In recurrent varices it is essential to distinguish between disease progression, including neorevascularisation, and technical errors. Endovascular procedures for elimination of the superficial venous system - radiofrequency obliteration and endovenous laser therapy - meanwhile have established themselves as alternative, minimally invasive procedures. The perioperative complication rate of endovenous procedures is very low and comparable to that of the classic operation. Good results, with occlusion rates of the treated vein around 87% to 93% up to 2 years postoperatively, have been published for both endovenous laser therapy and radiofrequency obliteration. For the latter, 5-year results were published, with occlusion of the treated vein in 87%. Results in the literature for radiofrequency are better documented than for endovenous laser treatment because there are now five prospective randomised trials for the former and most publications for endovenous laser treatment are single-center experiences. The advantage of endovenous procedures, especially radiofrequency obliteration, over the classic operation is the lower rate of perioperative pain and better quality of life. The spectrum of operative treatment methods of the superficial venous system has increased tremendously due to new technical developments. For the surgeon this implies the necessity of informing patients conscientiously about the pros and cons and available results of each procedure, and carefully weighing which methods are at the time best for the patient.
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Affiliation(s)
- T Noppeney
- Zentrum für Gefässmedizin, Obere Turnstrasse 8-10, 90429, Nürnberg, Deutschland.
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Rathbun SW, Kirkpatrick AC. Treatment of chronic venous insufficiency. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2007; 9:115-26. [PMID: 17484814 DOI: 10.1007/s11936-007-0005-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux. Treatment modalities are aimed at reducing venous valvular reflux, thereby inhibiting the ensuing pathologic inflammatory process. Compression therapy using pumps, bandaging, and/or graded compression stockings is the mainstay of treatment for CVI. Compression therapy has been shown to be effective in reducing venous hypertension retarding the development of inflammation and pathologic skin changes. Pharmacologic agents such as diuretics and topical steroid creams reduce swelling and pain short term but offer no long-term treatment advantage. Herbal supplements may reduce the inflammatory response to venous hypertension, but are not licensed by the US Food and Drug Administration, and vary in their efficacy, quality, and safety. However, several randomized controlled trials using the herbal horse chestnut seed extract containing aescin have shown short-term improvement in signs and symptoms of CVI. Endovascular and surgical techniques aimed at treatment of primary and secondary venous valvular reflux have been shown to improve venous hemodynamics promoting healing of venous ulcers and improving quality of life. The newer endovascular treatments of varicose veins using laser, radiofrequency ablation, and chemical foam sclerotherapy show some promise.
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Affiliation(s)
- Suman W Rathbun
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP 3120, Oklahoma City, OK 73104, USA.
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Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model. J Vasc Surg 2007; 45:1047-58. [DOI: 10.1016/j.jvs.2006.12.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 12/19/2006] [Indexed: 11/18/2022]
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Laser literature watch. Photomed Laser Surg 2006; 24:661-76. [PMID: 17069502 DOI: 10.1089/pho.2006.24.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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